| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BRIAN J BURCHFIELD3 Filed as: BRIAN J. BURCHFIELD | P.O. BOX 3414 CONCORD, NC 28025 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $36K | — | $36K | 3.83% |
| BURCHFIELD INSURANCE GROUP INC3 | 60 UNION STREET S CONCORD, NC 28025 | AMERITAS LIFE INSURANCE CORP. | $7K | — | $7K | 10.08% |
| IBSI HOLDINGS INC3 Filed as: IBSI HOLDINGS, INC. | P.O. BOX 24337 WINSTON SALEM, NC 27114 | AMERITAS LIFE INSURANCE CORP. | $3K | — | $3K | 4.00% |
| BURCHFIELD INSURANCE GROUP INC3 | P.O. BOX 3414 CONCORD, NC 28025 | USABLE LIFE | $2K | — | $2K | 11.41% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $955 | — | $955 | 5.06% |
| BURCH INSURANCE INC3 Filed as: BURCH | P.O. BOX 3414 CONCORD, NC 28025 | USABLE LIFE | $1K | — | $1K | 11.27% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $461 | — | $461 | 5.06% |
| BURCHFIELD INSURANCE GROUP INC3 | P.O. BOX 3414 CONCORD, NC 28025 | USABLE LIFE | $902 | — | $902 | 11.32% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $402 | — | $402 | 5.05% |
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 | 175 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 175 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 139 | $936K |
| Dental | AMERITAS LIFE INSURANCE CORP. | 239 | $66K |
| Vision | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 139 | $936K |
| Life insurance | USABLE LIFE | 175 | $8K |
| Short-term disability | USABLE LIFE | 175 | $9K |
| Long-term disability | USABLE LIFE | 175 | $19K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 139 | $936K |
| Other | USABLE LIFE | 175 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 239 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.