| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RALPH COOMER3 | PO BOX 1381 CARRBORO, NC 27510 | USABLE LIFE | $5K | — | $5K | 19.00% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $3K | — | $3K | 10.00% |
| RALPH COOMER3 | PO BOX 1381 CARRBORO, NC 27510 | USABLE LIFE | $4K | — | $4K | 15.00% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $1K | — | $1K | 5.00% |
| RALPH COOMER3 | PO BOX 1381 CARRBORO, NC 27510 | USABLE LIFE | $2K | — | $2K | 15.00% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $555 | — | $555 | 5.00% |
| RALPH COOMER3 | PO BOX 1381 CARRBORO, NC 27510 | USABLE LIFE | $483 | — | $483 | 14.98% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $161 | — | $161 | 4.99% |
| RALPH COOMER3 | PO BOX 1381 CARRBORO, NC 27510 | USABLE LIFE | $372 | — | $372 | 19.00% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $195 | — | $195 | 9.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF NC EIN 56-0894904 NONE | Insurance agents and brokers Service code 22 | PO BOX 2291 DURHAM, NC 27702 | $107K |
| SUZANNE JOHNSON NONE | Insurance agents and brokers Service code 22 | 6235 MORRISON BLVD CHARLOTTE, NC 28211 | $35K |
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 | 177 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 177 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | USABLE LIFE | 355 | $29K |
| Short-term disability | USABLE LIFE | 355 | $11K |
| Long-term disability | USABLE LIFE | 243 | $25K |
| Other | USABLE LIFE | 333 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 355 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.