| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GORDON, DAVID A3 | 902 S. CENTER ST GROVE CITY, PA 16127 | HIGHMARK INC | $32K | — | $32K | 2.26% |
| GORDON, DAVID A3 | 902 S. CENTER ST GROVE CITY, PA 16127 | HIGHMARK INC | $6K | — | $6K | 5.59% |
| ACRISURE LLC3 | 3737 PARK EAST DR STE 204 BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $891 | $7K | 17.19% |
| GROUP BENEFITS LTD3 | 3737 PARK EAST DR STE 204 BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 5.00% |
| ACRISURE LLC3 | 3737 PARK EAST DR STE 204 BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $520 | $4K | 17.52% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 5.00% |
| GORDON, DAVID A3 | 902 S. CENTER ST GROVE CITY, PA 16127 | HIGHMARK INC | $479 | — | $479 | 3.78% |
| ACRISURE LLC3 Filed as: ACRISURE MID-ATLANTIC PARTNERS INSU | 1265 DRUMMERS LN STE 300 WAYNE, PA 19087 | HIGHMARK INC | $13 | — | $13 | 0.10% |
| ACRISURE LLC3 | 3737 PARK EAST DR STE 204 BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $232 | $2K | 17.47% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $469 | $469 | 5.00% |
| ACRISURE LLC3 | 3737 PARK EAST DR STE 204 BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $83 | $1K | 15.94% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $440 | $440 | 5.00% |
| ACRISURE LLC3 | 3737 PARK EAST DR STE 204 BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $840 | $51 | $891 | 15.91% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $280 | $280 | 5.00% |
| ACRISURE LLC3 | 3737 PARK EAST DR STE 204 BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $533 | $229 | $762 | 14.30% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $266 | $266 | 4.99% |
| ACRISURE LLC3 | 3737 PARK EAST DR STE 204 BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $746 | $91 | $837 | 16.83% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $249 | $249 | 5.01% |
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 | 135 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 135 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HIGHMARK INC | 185 | $1.4M |
| Dental | HIGHMARK INC | 193 | $99K |
| Vision | HIGHMARK INC | 192 | $13K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 135 | $26K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 41 | $41K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 31 | $9K |
| Prescription drug | HIGHMARK INC | 65 | $236K |
| Other(5 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 135 | $45K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 193 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.