| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 42965 US-19 ALT PALM HARBOR, FL 34683 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $24K | — | $24K | 0.64% |
| CHEPENIK FINANCIAL SERVICES INC.3 Filed as: CHEPENIK FINANCIAL SERVICES INC | 429 S KELLER RD STE 310 ORLANDO, FL 32810 | SUN LIFE ASSURANCE COMPANY OF CANADA | $62K | — | $62K | 17.01% |
| ACRISURE LLC3 | 2965 US-19 ALT PALM HARBOR, FL 34683 | RELIASTAR LIFE INSURANCE COMPANY | $31K | — | $31K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 ADMINISTRATIVE SERVICES | Claims processing; Contract Administrator; Direct payment from the plan; Non-monetary compensation; Named fiduciary; Float revenue; Participant communication; Other services Service code 12 | — | $23K |
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 | 171 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 102 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 276 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 0 | $3.8M |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 262 | $365K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 262 | $365K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ILLINOIS | 0 | $3.8M |
| Stop-loss / reinsurancereinsurance | RELIASTAR LIFE INSURANCE COMPANY | 269 | $208K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 262 | $365K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 269 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.