| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RCM AND D3 Filed as: RCM & D | 555 FAIRMOUNT AVE BALTIMORE, MD 21286 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $16K | $16K | 2.00% |
| NFP INSURANCE SERVICES INC3 | 1250 S CAPITAL OF TEXAS HWY BLDG 2 W LAKE HILLS, TX 78746 | PRINCIPAL LIFE INSURANCE COMPANY | — | $5K | $5K | 1.72% |
| GARRY LYNN JOHNSON3 | 3850 E BASELINE RD, STE 121 MESA, AZ 85206 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | — | $3K | 1.00% |
| BLOCK, CHARLES, D3 | UNIT 208 648 VILLAGE PARK DR WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 4.46% |
| RCM AND D3 Filed as: RCM & D | 555 FAIRMOUNT AVE BALTIMORE, MD 21286 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 2.12% |
| GARRY LYNN JOHNSON3 | 3850 E BASELINE RD, STE 121 MESA, AZ 85206 | PRINCIPAL LIFE INSURANCE COMPANY | $21 | — | $21 | 0.99% |
| BLOCK, CHARLES, D3 | UNIT 208 648 VILLAGE PARK DR WILMINGTON, NC 28405 | FIRST UNUM LIFE INSURANCE COMPANY | $41 | — | $41 | 3.01% |
| RCM AND D3 Filed as: RCM & D | 555 FAIRMOUNT AVE BALTIMORE, MD 21286 | FIRST UNUM LIFE INSURANCE COMPANY | $22 | — | $22 | 1.62% |
No Schedule C service providers reported on this filing.
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 | 1,271 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,271 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Short-term disability(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 178 | $55K |
| Long-term disability(4 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,273 | $1.1M |
| Other(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 178 | $55K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,273 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.