| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SEACREST PARTNERS, INC.3 Filed as: SEACREST PARTNERS, INC | PO BOX 8004 SAVANNAH, GA 31404 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHGRAM EIN 56-1449504 THIRD PARTY ADMINISTRATOR | Plan Administrator Service code 14 | P.O. BOX 11088 CHARLOTTE, NC 28220 | $147K |
| ENVISIONRX EIN 90-1011712 BENEFITS MANAGER | Claims processing Service code 12 | 2181 E. AURORA RD., SUITE 201 TWINSBURG, OH 44087 | $19K |
| MEDCOST EIN 22-2360010 CONSULTANT | Consulting (general) Service code 16 | P.O. BOX 11088 CHARLOTTE, NC 28220 | $8K |
| FIRST HEALTH NETWORK EIN 20-1736473 CONSULTANT | Consulting (general) Service code 16 | P.O. BOX 11088 CHARLOTTE, NC 28220 | $6K |
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 | 648 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 648 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 723 | $69K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 456 | $105K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 646 | $522K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 578 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 723 | — |
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.