| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MAIN STREET FINANCIAL GROUP3 Filed as: MAIN STREET INSURANCE GROUP | 22 N TRADE STREET TRYON, NC 28782 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | $0 | $4K | 13.76% |
| UNITED PRODUCERS GROUP LLC3 | 1439 STUART ENGALS BLVD SUITE 300 MOUNT PLEASANT, SC 29464 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 4.47% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF NC EIN 56-0894904 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $11K |
| THOMAS C FLACK BROKER | Insurance agents and brokers Service code 22 | 123 E MAIN STREET FOREST CITY, NC 28043 | $10K |
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 | 26 | 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) | 26 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 35 | $28K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 35 | $28K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 35 | $28K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 26 | $83K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 35 | — |
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.