| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 495011788 | ANTHEM BLUE CROSS | $111K | $17K | $128K | 3.20% |
| PROFESSIONAL GROUP PLANS INC3 | 225 WIRELESS BOULEVARD SUITE 200 HAUPPAUGE, NY 117883914 | ANTHEM BLUE CROSS | — | $61K | $61K | 1.53% |
| LAVITANUOVA LLC3 | 252 7TH STREET 6B NEW YORK, NY 10001 | ANTHEM BLUE CROSS | $17K | $29K | $46K | 1.16% |
| PGM INSURANCE SERVICES, LLC3 Filed as: PGM INSURANCE SERVICES LLC | 311 CLOCK TOWER COMMONS BREWSTER, NY 10509 | ANTHEM BLUE CROSS | — | $9K | $9K | 0.22% |
| ACRISURE LLC3 Filed as: ACRISURE NORTHWEST PARTNERS INS SVC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 495035087 | KAISER FOUNDATION HEALTH PLAN INC | $3K | — | $3K | 2.87% |
| BELL-ANDERSON AGENCY INC3 | 600 SW 39TH STREET SUITE 200 RENTON, WA 980574919 | KAISER FOUNDATION HEALTH PLAN INC | $1K | — | $1K | 1.27% |
| BELL-ANDERSON AGENCY INC3 | 600 SW 39TH STREET SUITE 200 RENTON, WA 98057 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $2K | — | $2K | 2.18% |
| ACRISURE LLC3 Filed as: ACRISURE NORTHWEST PARTNERS INS SVC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 495035087 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $1K | — | $1K | 1.86% |
| PROFESSIONAL GROUP PLANS INC3 | 225 WIRELESS BOULEVARD FLOOR 2 HAUPPAUGE, NY 11788 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $3K | $3K | 5.00% |
| ACRISURE LLC3 | 525 7TH AVENUE ROOM 1800 NEW YORK, NY 10018 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $2K | $2K | 3.66% |
| ACRISURE LLC3 | 525 7TH AVENUE ROOM 1800 NEW YORK, NY 10018 | MUTUAL OF OMAHA INSURANCE COMPANY | $3K | $1K | $4K | 13.65% |
| PROFESSIONAL GROUP PLANS INC3 | 225 WIRELESS BOULEVARD FLOOR 2 HAUPPAUGE, NY 11788 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $2K | $2K | 5.00% |
| PROFESSIONAL GROUP PLANS INC3 | 225 WIRELESS BOULEVARD FLOOR 2 HAUPPAUGE, NY 11788 | COMPANION LIFE INSURANCE COMPANY | — | $1K | $1K | 5.00% |
| ACRISURE LLC3 | 525 7TH AVENUE ROOM 1800 NEW YORK, NY 10018 | COMPANION LIFE INSURANCE COMPANY | $159 | $832 | $991 | 4.35% |
| ACRISURE LLC3 | 525 7TH AVENUE ROOM 1800 NEW YORK, NY 10018 | MUTUAL OF OMAHA INSURANCE COMPANY | $414 | $217 | $631 | 10.67% |
| PROFESSIONAL GROUP PLANS INC3 | 225 WIRELESS BOULEVARD FLOOR 2 HAUPPAUGE, NY 11788 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $296 | $296 | 5.01% |
| ACRISURE LLC3 | 525 7TH AVENUE ROOM 1800 NEW YORK, NY 10018 | MUTUAL OF OMAHA INSURANCE COMPANY | $190 | $114 | $304 | 16.00% |
No Schedule C service providers reported on this filing.
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 | 315 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 321 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | ANTHEM BLUE CROSS | 288 | $4.2M |
| Dental | ANTHEM BLUE CROSS | 288 | $4.0M |
| Vision | ANTHEM BLUE CROSS | 288 | $4.0M |
| Life insurance(2 contracts, 2 carriers) | COMPANION LIFE INSURANCE COMPANY | 303 | $29K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 303 | $30K |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 303 | $50K |
| Other(2 contracts) | MUTUAL OF OMAHA INSURANCE COMPANY | 301 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 303 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.