| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EBENCONCEPTS COMPANY3 | 921-C S. MCPHERSON CHURCH ROAD FAYETTEVILLE, NC 28303 | USABLE LIFE | $721 | — | $721 | 9.35% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP | 4605 UNIVERSITY DRIVE DURHAM, NC 27707 | USABLE LIFE | $360 | — | $360 | 4.67% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS AND BLUE SHIELD OF NC EIN 56-0894904 ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $84K |
| EBENCONCEPTS COMPANY, INC. CONSULTANT | Consulting (general) Service code 16 | 921-C S. MCPHERSON CHURCH ROAD FAYETTEVILLE, NC 28303 | $46K |
| DAVIDSON HOLLAND WHITESELL & CO PLL EIN 56-1706742 AUDITOR | Accounting (including auditing) Service code 10 | — | $13K |
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 | 185 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 185 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 185 | $161K |
| Life insurance | USABLE LIFE | 183 | $8K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 185 | $161K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 185 | $161K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 185 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.