| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DALE MOORE3 | PO BOX 220748 CHARLOTTE, NC 28222 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $37K | $0 | $37K | 2.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62819 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $6K | $1K | $7K | 11.98% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP SERVICES, LLC | PO BOX 2291 DURHAM, NC 27702 | HARTFORD LIFE AND ACCIDENT | $0 | $4K | $4K | 7.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | USABLE LIFE | $5K | $96 | $5K | 12.17% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $3K | $0 | $3K | 7.07% |
| USI INSURANCE SERVICES LLC3 | 1 CONCOURSE CENTER PARKWAY SUITE 700 ATLANTA, GA 30328 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $154 | $3K | 20.28% |
| SHEALY BENEFITS SERVICES INC3 Filed as: SHEALY BENEFITS SERVICES, INC. | 215 HOGAN WAY LEXINGTON, SC 29072 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 18.70% |
No Schedule C service providers reported on this filing.
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 | 222 | 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) | 222 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 210 | $1.8M |
| Dental | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 210 | $1.8M |
| Vision | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 210 | $1.8M |
| Life insurance | USABLE LIFE | 222 | $40K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 87 | $57K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 87 | $57K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 210 | $1.8M |
| Other(2 contracts, 2 carriers) | USABLE LIFE | 222 | $55K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 222 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.