| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EBENCONCEPTS COMPANY3 | 15305 DALLAS PARKWAY SUITE 800 ADDISON, TX 75001 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | — | $10K | 2.12% |
| EBENCONCEPTS COMPANY3 | 15305 DALLAS PARKWAY STE 800 ADDISON, TX 75001 | STARMOUNT LIFE INSURANCE COMPANY | $2K | — | $2K | 2.16% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF NORTH CAR EIN 56-0894904 ADMINSTRATOR | Claims processing Service code 12 | — | $479K |
| VICKERY FAMILY MEDICINE ONSITE MEDICAL CLINIC | Other fees Service code 99 | 15 GRIFFING BLVD. ASHEVILLE, NC 28804 | $376K |
| EBENCONCEPTS COMPANY EIN 75-2966596 CONSULTANT | Consulting fees; Consulting (general) Service code 16 | — | $70K |
| UNUM LIFE INSURANCE COMPANY OF AMER EIN 01-0278678 ADMIN SERVICE PROVIER | Other fees; Contract Administrator Service code 13 | — | $33K |
| EMPLOYEE ASSISTANCE NETWORK INC EAP SERVICE PROVIDER | Other fees Service code 99 | 5 DOCTORS PARK E1 ASHEVILLE, NC 28801 | $26K |
| RANGE URGENT CARE, PLLC EIN 81-4367173 AFTER HOURS MED SUPPORT | Other fees Service code 99 | — | $7K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 1,050 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,050 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 862 | $75K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,050 | $476K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,050 | $476K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,050 | $476K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 864 | $746K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,050 | $476K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,050 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.