| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MEDCOST BENEFIT SERVICES3 Filed as: MEDCOST BENEFIT SERVICES LLC | 165 KIMEL PARK DRIVE WINSTON-SALEM, NC 27103 | HM LIFE INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY, INC. | PO BOX 9375 GREENSBORO, NC 27429 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $477 | — | $477 | 2.84% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY, INC. | PO BOX 9375 GREENSBORO, NC 27429 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $660 | $2K | 13.52% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MEDCOST BENEFIT SERVICES EIN 56-2056821 TPA | Contract Administrator Service code 13 | — | $93K |
| SENN, DUNN, MARSH & ROLAND, INC. EIN 56-0373700 CONSULTANT | Insurance agents and brokers Service code 22 | — | $25K |
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 | 328 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 328 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 290 | $17K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 328 | $15K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 264 | $380K |
| Other(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 328 | $37K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 328 | — |
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.