| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EUGENE BAIN JR.3 | P.O. BOX 53574 FAYETTEVILLE, NC 28305 | RELIANCE STANDARD | $3K | — | $3K | 5.89% |
| EUGENE BAIN JR.3 | P.O. BOX 53574 FAYETTEVILLE, NC 28305 | RELIANCE STANDARD | $2K | — | $2K | 12.50% |
| NFP INSURANCE SERVICES INC3 | 1250 CAPITAL OF TX HWY BLDG II 600 AUSTIN, TX 78746 | RELIANCE STANDARD | — | $179 | $179 | 1.47% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INTERACTIVE MEDICAL SYSTEMS CORP NONE | Contract Administrator Service code 13 | 11635 NORTH PARK DR. SUITE 330 WAKE FOREST, NC 27587 | $47K |
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 | 114 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | RELIANCE STANDARD | 200 | $46K |
| Life insurance | RELIANCE STANDARD | 109 | $12K |
| Short-term disability | RELIANCE STANDARD | 109 | $12K |
| Stop-loss / reinsurancereinsurance | GERBER LIFE | 81 | $170K |
| Other | RELIANCE STANDARD | 109 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 200 | — |
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.