| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MEDCOST BENEFIT SERVICES | 165 KIMEL PARK DR SUITE 100 WINSTON-SALEM, NC 27103 | UNIMERICA INSURANCE COMPANY | — | $5K | $5K | 1.58% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY - SENN DUNN | 1400 EASTCHESTER DR SUITE 200 HIGH POINT, NC 27265 | THE PAUL REVERE LIFE INSURANCE COMPANY | $387 | $2K | $2K | 2.08% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY - SENN DUNN | 1400 EASTCHESTER DR SUITE 200 HIGH POINT, NC 27265 | THE PAUL REVERE LIFE INSURANCE COMPANY | $4K | $481 | $4K | 15.48% |
| FLOYD A BELL3 | 4213 HENDERSON RD GREENSBORO, NC 27410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 1.73% |
| H FLETCHER RIFFEY3 | 5612 GREENWICH DR GREENSBORO, NC 27410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 1.73% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MEDCOST BENEFIT SERVICES EIN 56-2056821 | Contract Administrator Service code 13 | PO BOX 24042 WINSTON-SALEM, NC 27114 | $64K |
| MARSH & MCLENNAN AGENCY - SENN DUNN EIN 56-0373700 BROKER | Insurance agents and brokers Service code 22 | 1400 EASTERCHESTER DR SUITE 200 HIGH POINT, NC 27265 | $12K |
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 | 204 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 204 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | THE PAUL REVERE LIFE INSURANCE COMPANY | 195 | $98K |
| Short-term disability | THE PAUL REVERE LIFE INSURANCE COMPANY | 195 | $97K |
| Long-term disability | THE PAUL REVERE LIFE INSURANCE COMPANY | 76 | $26K |
| Stop-loss / reinsurancereinsurance | UNIMERICA INSURANCE COMPANY | 180 | $327K |
| Other | THE PAUL REVERE LIFE INSURANCE COMPANY | 195 | $97K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 195 | — |
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.