| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DAVID SIMAS3 | 6100 FAIRVIEW ROAD, SUITE 1000 CHARLOTTE, NC 28210 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $80K | $0 | $80K | 2.72% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP SERVICES, LLC | 4615 UNIVERSITY DRIVE DURHAM, NC 27707 | SYMETRA LIFE INSURANCE COMPANY | $6K | $0 | $6K | 4.34% |
| USI INSURANCE SERVICES LLC3 | 6100 FAIRVIEW ROAD, SUITE 1400 CHARLOTTE, NC 28210 | SYMETRA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 2.62% |
| USI INSURANCE SERVICES LLC3 | 312 ELM STREET, 24TH FLOOR CINCINNATI, OH 45202 | SYMETRA LIFE INSURANCE COMPANY | $0 | $473 | $473 | 0.33% |
| USI INSURANCE SERVICES LLC3 | 6000 CLEARWATER DRIVE MINNETONKA, MN 55343 | SYMETRA LIFE INSURANCE COMPANY | $0 | $355 | $355 | 0.25% |
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 | 252 | 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) | 252 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 519 | $3.0M |
| Dental | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 519 | $3.0M |
| Vision | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 519 | $3.0M |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 239 | $142K |
| Short-term disability | SYMETRA LIFE INSURANCE COMPANY | 239 | $142K |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 239 | $142K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 519 | $3.0M |
| Other | SYMETRA LIFE INSURANCE COMPANY | 239 | $142K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 519 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.