| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DONALD C SAVOY INC3 | 258 HANOVER ROAD SUITE 220 FLORHAM PARK, NJ 07932 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $11K | $1K | $12K | 8.63% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC DBA RPM INSURANCE | 201 EDWARD CURRY AVENUE SUITE 201 STATEN ISLAND, NY 10314 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 1.27% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 555 TAXTER ROAD SUITE 125 ELMSFORD, NY 10523 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $682 | — | $682 | 0.48% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC DBA RPM INSURANCE | 201 EDWARD CURRY AVENUE SUITE 201 STATEN ISLAND, NY 10314 | FIRST UNUM LIFE INSURANCE COMPANY | $5K | $380 | $6K | 10.44% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR CALENDONIA, MI 49316 | FIRST UNUM LIFE INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC DBA RPM INSURANCE | 201 EDWARD CURRY AVENUE SUITE 201 STATEN ISLAND, NY 10314 | MERITAIN HEALTH | $43K | — | $43K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ACRISURE, LLC DBA RPM INSURANCE INSURANCE AGENT | Insurance services; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | 201 EDWARD CURRY AVENUE SUITE 201 STATEN ISLAND, NY 10314 | $51K |
| DONALD C SAVOY INC GENERAL AGENCY | Other insurance fees and expenses; Plan Administrator; Insurance brokerage commissions and fees Service code 14 | 258 HANOVER ROAD SUITE 220 FLORHAM PARK, NJ 07932 | $12K |
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 | 192 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 192 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MERITAIN HEALTH | 148 | $0 |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 189 | $142K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 189 | $142K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 172 | $54K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 189 | $142K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 172 | $54K |
| Other | FIRST UNUM LIFE INSURANCE COMPANY | 172 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 189 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.