| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACS BENEFIT SERVICES LLC3 | 470 W. HANES MILL ROAD STE 100 WINSTON SALEM, NC 27105 | COMPANION LIFE INSURANCE COMPANY DBA IISI | $9K | — | $9K | 10.00% |
| DENNIS INSURANCE3 Filed as: DENNIS INSURANCE & FINANCIAL SERVIC | 901 BATTLEGROUND AVE STE A GREENSBORO, NC 27408 | STARMOUNT LIFE INSURANCE COMPANY | $1K | $102 | $2K | 11.89% |
| EBENCONCEPTS COMPANY3 | 15305 DALLAS PARKWAY STE 800 ADDISON, TX 75001 | STARMOUNT LIFE INSURANCE COMPANY | $115 | $19 | $134 | 1.03% |
| DENNIS INSURANCE3 Filed as: DENNIS INSURANCE & FINANCIAL SERVI | 901 BATTLEGROUND AVE STE A GREENSBORO, NC 27408 | USABLE LIFE | $289 | — | $289 | 9.90% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $144 | — | $144 | 4.93% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ACS BENEFIT SERVICES, LLC EIN 56-1472467 CLAIMS ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $61K |
| VOLTAIRE HEALTH, LLC DBA PAYER COMP EIN 46-2047081 OTHER SERVICE PROVIDER | Other services Service code 49 | — | $32K |
| DENNIS INSURANCE & FINANCIAL SERVIC EIN 56-1861994 BROKER | Insurance brokerage commissions and fees Service code 53 | — | $31K |
| LEGACY INSURANCE PARTNERS, INC. EIN 84-3748559 BROEKR | Insurance brokerage commissions and fees Service code 53 | — | $3K |
| SELF FUNDING ACTUARIAL SERVICES EIN 56-1472476 ACTUARIAL | Actuarial Service code 11 | — | $450 |
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 | 170 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 170 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMPANION LIFE INSURANCE COMPANY DBA IISI | 170 | $94K |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 136 | $13K |
| Life insurance | USABLE LIFE | 168 | $3K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE INSURANCE COMPANY DBA IISI | 170 | $94K |
| Other | USABLE LIFE | 168 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 170 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.