| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: CHERNOFF DIAMOND & CO LLC | 725 RXR PLAZA EAST TOWER UNIONDALE, NY 11556 | CIGNA GROUP INSURANCE | $2K | — | $2K | 9.74% |
| ACRISURE LLC3 Filed as: CHERNOFF DIAMOND & CO LLC | 725 RXR PLAZA EAST TOWER UNIONDALE, NY 11556 | CIGNA GROUP INSURANCE | $368 | — | $368 | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CORE SOURCE, INC. EIN 35-1846036 NONE | Claims processing; Plan Administrator; Other services Service code 12 | — | $81K |
| AETNA-PPO EIN 06-6033492 NONE | Other services; Claims processing Service code 12 | — | $28K |
| HEALTH FITNESS EIN 41-1580506 NONE | Claims processing Service code 12 | — | $11K |
| MULTIPLAN EIN 43-6004435 NONE | Other services; Claims processing; Plan Administrator Service code 12 | — | $8K |
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 | 187 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 187 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | CIGNA GROUP INSURANCE | 0 | $21K |
| Long-term disability | CIGNA GROUP INSURANCE | 0 | $34K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 0 | — |
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.