| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MEMBER RESOURCES INC3 | 8531 CROWN CRESCENT COURT STE A CHARLOTTE, NC 28227 | NATIONWIDE LIFE INSURANCE COMPANY | $12K | — | $12K | 7.00% |
| MEMBER RESOURCES INC3 | 8531 CROWN CRESCENT COURT STE A CHARLOTTE, NC 28227 | SYMETRA LIFE INSURANCE COMPANY | $9K | — | $9K | 7.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF NC EIN 56-0894904 NONE | Claims processing Service code 12 | PO BOX 2291 DURHAM, NC 27702 | $403K |
| SYMETRA LIFE INSURANCE EIN 91-0742147 NONE | Claims processing Service code 12 | PO BOX 34690 SEATTLE, WA 981241690 | $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 | 726 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | NATIONWIDE LIFE INSURANCE COMPANY | 877 | $175K |
| Short-term disability | SYMETRA LIFE INSURANCE COMPANY | 877 | $129K |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 877 | $129K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF NC | 1,306 | $285K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,306 | — |
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.