| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROSENFELD EINSTEIN3 | 870 S PLEASANTBURG DR GREENVILLE, SC 29607 | BLUE CROSS AND BLUE SHIELD | $3K | — | $3K | 0.07% |
| ROY W KEITH5 | — | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3K | — | $3K | 4.37% |
| PAULA H KEEL5 | — | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $2K | — | $2K | 2.58% |
| BRAD HUGHES AGCY INC3 | — | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | — | $1K | 1.75% |
| MICHELLE GLOWACKI3 | 20 HELTON DRIVE APT 1314 COLUMBIA, SC 29229 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $169 | — | $169 | 0.23% |
| THOMAS S HAISLOP3 | — | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $11 | — | $11 | 0.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD EIN 57-0287419 SERVICE PROVIDER | Insurance services Service code 23 | — | $301K |
| CIGNA HEALTH AND LIFE INSURANCE EIN 59-1031071 SERVICE PROVIDER | Claims processing; Contract Administrator Service code 12 | — | $20K |
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 | 35 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 18 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 53 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 123 | $74K |
| Vision | BLUE CROSS AND BLUE SHIELD | 176 | $4.4M |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 430 | $108K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS AND BLUE SHIELD | 176 | $4.4M |
| Other(3 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 430 | $208K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 430 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
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.