| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EBENCONCEPTS COMPANY3 Filed as: EBENCONCEPTS COMPANY, INC. | 921-C S. MCPHERSON CHURCH ROAD FAYETTEVILLE, NC 28303 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $31K | — | $31K | 10.48% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 2405 SATELLITE BOULEVARD SUITE 200 DULUTH, GA 30096 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | — | $4K | 1.22% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EBENCONCEPTS COMPANY, INC. EIN 75-2966596 CONSULTANT | Other fees Service code 99 | — | $60K |
| BLUE CROSS BLUE SHIELD NORTH CAROLI EIN 56-0894904 TPA | Actuarial; Insurance agents and brokers Service code 11 | — | $51K |
| TELADOC HEALTH, INC. EIN 04-3705970 TELEMEDICINE | Other fees Service code 99 | — | $6K |
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 | 132 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 132 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 132 | $389K |
| Dental | RELIANCE STANDARD LIFE INSURANCE COMPANY | 132 | $295K |
| Vision | COMMUNITY EYE CARE | 363 | $20K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 132 | $295K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 132 | $295K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 132 | $295K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 132 | $389K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 132 | $389K |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 132 | $295K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 363 | — |
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.