| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAMERON M. HARRIS AND COMPANY3 Filed as: CAMERON M HARRIS & COMPANY, LLC | 6400 FAIRVIEW ROAD CHARLOTTE, NC 28210 | HCC LIFE INSURANCE COMPANY | $65K | — | $65K | 4.19% |
| CORESOURCE, INC.3 | 5200 77 CENTER DRIVE, SUITE 400 CHARLOTTE, NC 282170718 | HCC LIFE INSURANCE COMPANY | $18K | — | $18K | 1.16% |
| CORESOURCE, INC.3 Filed as: CORESOURCE | 5200 UPPER METRO PL STE 300 DUBLIN, OH 430175378 | VISION SERVICE PLAN | $36K | — | $36K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CORESOURCE, INC. EIN 35-1846036 BENEFIT ADMINISTRATOR | Claims processing; Plan Administrator; Other services Service code 12 | — | $2.0M |
| AETNA - PPO EIN 06-6033492 NONE | Claims processing; Other services Service code 12 | — | $254K |
| MEDCOST EIN 56-1999192 NONE | Claims processing Service code 12 | — | $194K |
| MULTIPLAN EIN 43-6004435 NONE | Plan Administrator; Claims processing; Other services Service code 12 | — | $99K |
| PHCS EIN 13-3068979 NONE | Claims processing Service code 12 | — | $48K |
| ACS EIN 36-4129784 NONE | Claims processing; Other services Service code 12 | — | $35K |
| FIRST HEALTH EIN 20-1736437 NONE | Claims processing Service code 12 | — | $23K |
| DIXON HUGHES GOODMAN LLP EIN 56-0747981 ACCOUNTANT | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $22K |
| EMPLOYEE BENEFITS CORP EIN 39-2044064 NONE | Other services Service code 49 | — | $9K |
| VIRGINIA HEALTH NETWORK EIN 54-1389446 NONE | Claims processing Service code 12 | — | $8K |
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 | 6,596 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 40 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 6,636 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN, INC. | 787 | $5.4M |
| Vision | VISION SERVICE PLAN | 3,527 | $361K |
| Life insurance | HCC LIFE INSURANCE COMPANY | 6,701 | $1.6M |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 6,701 | $1.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,701 | — |
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."
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.