| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | THE HARTFORD INSURANCE COMPANY | — | $323 | $323 | 1.43% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF GA EIN 58-1638390 NONE | Other services; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator Service code 12 | — | $159K |
| NAT'L EMPLOYEE BENEFITS ADMIN. INC. EIN 65-0498809 NONE | Contract Administrator; Other services Service code 13 | — | $99K |
| ACRISURE EIN 59-1258855 NONE | Insurance brokerage commissions and fees; Insurance agents and brokers; Consulting (general) Service code 16 | — | $62K |
| ROBEIN, URANN, SPENCER, PICARD EIN 72-0999672 NONE | Legal Service code 29 | — | $53K |
| PROCARE PHARMACY BENEFIT MANAGER EIN 58-2422694 NONE | Contract Administrator; Claims processing Service code 12 | — | $30K |
| DREXI, INC EIN 46-4488538 NONE | Contract Administrator; Claims processing Service code 12 | — | $27K |
| LEGACY PROFESSIONALS EIN 32-0043599 NONE | Accounting (including auditing) Service code 10 | — | $22K |
| AULT INTERNATIONAL MEDICAL MGT LLC EIN 93-4718961 NONE | Other services Service code 49 | — | $21K |
| PLUMBERS & PIPEFITTERS U.A. L. 188 RELATED LOCAL UNION | Other services Service code 49 | 2337 E. VICTORY DRIVE SAVANNAH, GA 31404 | $21K |
| LIFE LINE SCREENING OF AMERICA EIN 34-1839775 NONE | Other services Service code 49 | — | $15K |
| UNITED ACTUARIAL SERVICES INC EIN 35-2156428 NONE | Actuarial Service code 11 | — | $12K |
| TOP DRAWER INC. EIN 59-1550960 NONE | Other services Service code 49 | — | $10K |
| GLOBAL RX NONE | Claims processing; Contract Administrator Service code 12 | 1321 UPLAND DR SUITE 819 HOUSTON, TX 77043 | $9K |
| LAUREL MOUNTAIN CONSULTING LLC EIN 83-2320285 NONE | Other services Service code 49 | — | $6K |
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 | 273 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 88 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 361 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPHESYS INSURANCE COMPANY | 117 | $276K |
| Life insurance | THE HARTFORD INSURANCE COMPANY | 340 | $23K |
| Stop-loss / reinsurancereinsurance | BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY | 263 | $438K |
| Other | THE HARTFORD INSURANCE COMPANY | 340 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 340 | — |
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."
No prospect flags tripped on this filing.