| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COOMER, RALPH | PO BOX 1381 CARRBORO, NC 27510 | USABLE LIFE | $10K | — | $10K | 19.00% |
| MOSAIC GROUP SERVICES | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $5K | — | $5K | 10.00% |
| COOMER, RALPH3 | PO BOX 1381 CARRBORO, NC 27510 | USABLE LIFE | $8K | — | $8K | 19.00% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $4K | — | $4K | 10.00% |
| COOMER, RALPH3 | PO BOX 13881 CARRBORO, NC 27510 | USABLE LIFE | $6K | — | $6K | 19.00% |
| MOSIAC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $3K | — | $3K | 10.00% |
| COOMER, RALPH3 | PO BOX 1381 CARRBORO, NC 27510 | USABLE LIFE | $4K | — | $4K | 15.00% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $1K | — | $1K | 5.00% |
| COOMER, RALPH3 | POST OFFICE BOX 1381 CARRBORO, NC 27510 | USABLE LIFE | $3K | — | $3K | 15.00% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $1K | — | $1K | 5.00% |
| COOMER, RALPH3 | POST OFFICE BOX 1381 CARBORO, NC 27510 | USABLE LIFE | $2K | — | $2K | 15.00% |
| MOSIAC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $611 | — | $611 | 5.00% |
| COOMER, RALPH3 | PO BOX 1381 CARRBORO, NC 27510 | USABLE LIFE | $1K | — | $1K | 15.91% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $392 | — | $392 | 5.31% |
| COOMER, RALPH3 | POST OFFICE BOX 1381 CARRBORO, NC 27510 | USABLE LIFE | $509 | — | $509 | 14.99% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $170 | — | $170 | 5.01% |
| COOMER, RALPH3 | PO BOX 1381 CARRBORO, NC 27510 | USABLE LIFE | $593 | — | $593 | 19.01% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $312 | — | $312 | 10.00% |
| COOMER, RALPH3 | POST OFFICE BOX 1381 CARBORO, NC 27510 | USABLE LIFE | $446 | — | $446 | 18.99% |
| MOSIAC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $235 | — | $235 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF NC EIN 56-0894904 NONE | Insurance agents and brokers Service code 22 | — | $67K |
| RALPH A. COOMER EIN 24-8047613 NONE | Consulting (general); Insurance agents and brokers Service code 16 | — | $35K |
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 | 357 | 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) | 357 | Active + retired/separated + beneficiaries. No dependents. |
No Schedule A insurance contracts on this filing — typical of fully self-funded plans, where the only headcount is the Form 5500 number above.
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.