| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACS BENEFIT SERVICES LLC3 | 5660 UNIVERSITY PARKWAY 5TH FLOOR WINSTON SALEM, NC 27105 | GERBER LIFE INSURANCE COMPANY | $10K | — | $10K | 2.91% |
| EBENCONCEPTS COMPANY3 | 3150 NORTH ELM STE 201 GREENSBORO, NC 27408 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $16K | — | $16K | 10.00% |
| EBENCONCEPTS COMPANY3 | 3150 NORTH ELM STE 201 GREENSBORO, NC 27408 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $24K | — | $24K | 21.33% |
| ACE BENEFIT SERVICES LLC3 | 7 W HANES MILL ROAD SUITE WINSTON SALEM, NC 27105 | TELADOC HEALTH INC | $961 | — | $961 | 20.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ACS BENEFIT SERVICES LLC EIN 56-1472467 CLAIMS ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $52K |
| EBENCONCEPTS COMPANY EIN 75-2966596 BROKER | Insurance brokerage commissions and fees Service code 53 | — | $25K |
| MEDCOST LLC EIN 56-1999192 OTHER SERVICE PROVIDER | Other services Service code 49 | — | $13K |
| VOLTAIRE HEALTH LLC EIN 46-2047081 OTHER SERVICES PROVIDER | Other services Service code 49 | — | $4K |
| SELF FUNDING ACTUARIAL SERVICES EIN 56-1472476 ACTUARIAL | Actuarial Service code 11 | — | $400 |
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 | 163 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 163 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | TELADOC HEALTH INC | 159 | $5K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 163 | $158K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 159 | $113K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 159 | $113K |
| Stop-loss / reinsurancereinsurance | GERBER LIFE INSURANCE COMPANY | 159 | $356K |
| Other(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 159 | $118K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 163 | — |
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.