| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | UNITEDHEALTHCARE INSURANCE COMPANY | $49K | — | $49K | 3.33% |
| ACRISURE LLC3 Filed as: ACRISURE PGM INSURANCE SERVICES LLC | 50 BROADWAY HAWTHORNE, NY 10532 | UNITEDHEALTHCARE INSURANCE COMPANY | $17K | — | $17K | 1.18% |
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | UNITEDHEALTHCARE INSURANCE COMPANY | $4K | — | $4K | 4.56% |
| ACRISURE LLC3 Filed as: ACRISURE PGM INSURANCE SERVICES LLC | 50 BROADWAY HAWTHORNE, NY 10532 | UNITEDHEALTHCARE INSURANCE COMPANY | $4K | — | $4K | 4.56% |
| ROBIN GRUND3 | 27 BARNES RD OSSINGING, NY 10562 | UNITEDHEALTHCARE INSURANCE COMPANY | -$4 | — | -$4 | -0.00% |
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | UNITEDHEALTHCARE INSURANCE COMPANY | $909 | — | $909 | 9.16% |
| ACRISURE LLC3 Filed as: ACRISURE PGM INSURANCE SERVICES LLC | 50 BROADWAY HAWTHORNE, NY 10532 | UNITEDHEALTHCARE INSURANCE COMPANY | $454 | — | $454 | 4.57% |
| ROBIN GRUND3 | 27 BARNES RD OSSINING, NY 10562 | UNITEDHEALTHCARE INSURANCE COMPANY | $1 | — | $1 | 0.01% |
| ROBIN GRUND3 | 27 BARNES RD OSSINING, NY 10562 | UNITEDHEALTHCARE INSURANCE COMPANY | $1K | — | $1K | 12.53% |
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 | 118 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 118 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 117 | $1.5M |
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 118 | $85K |
| Vision(2 contracts) | UNITEDHEALTHCARE INSURANCE COMPANY | 117 | $1.5M |
| Life insurance | UNITEDHEALTHCARE INSURANCE COMPANY | 185 | $9K |
| Other | UNITEDHEALTHCARE INSURANCE COMPANY | 185 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 185 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.