| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | P O BOX 1788 GRAND RAPIDS, MI 49501 | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | — | $262 | $262 | 0.06% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA | PEACHTREE BENEFIT GROUP 3580 PIERCE DRIVE NE SUITE 100 CHAMBLEE, GA 30341 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $27K | $18K | $45K | 14.82% |
| ACRISURE LLC3 | 330 SUPERIOR MALL PORT HURON, MI 48060 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $19K | — | $19K | 6.25% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA | PEACHTREE BENEFIT GROUP 3580 PIERCE DR NE STE 100 CHAMBLEE, GA 30341 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $12K | $9K | $20K | 15.23% |
| ACRISURE LLC3 Filed as: ARISURE LLC | 330 SUPERIOR MALL PORT HURON, MI 48060 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 6.25% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA | PEACHTREE BENEFIT GROUP 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30341 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $7K | $16K | 15.87% |
| ACRISURE LLC3 | 330 SUPERIOR MALL PORT HURON, MI 48060 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 6.25% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA | PEACHTREE BENEFIT GROUP 3580 PIERCE DRIVE NE STE 100 CHAMBLEE, GA 30341 | MUTUAL OF OMAHA INSURANCE COMPANY | $2K | $1K | $3K | 15.47% |
| ACRISURE LLC3 | 330 SUPERIOR MALL PORT HURON, MI 48060 | MUTUAL OF OMAHA INSURANCE COMPANY | $1K | — | $1K | 6.25% |
| UNITED OF OMAHA LIFE INSURANCE CO5 | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $7K | $7K | 96.47% |
| ACRISURE LLC3 | 330 SUPERIOR MALL PORT HURON, MI 48060 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $267 | $267 | 3.53% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD HEALTH PL GA EIN 58-1638390 ADMIN | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Float revenue Service code 12 | — | $448K |
| INGENIORX INC EIN 82-3062245 PHARM ADMIN | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Float revenue Service code 12 | — | $204K |
| ACRISURE LLC BROKER | Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30341 | $65K |
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 | 336 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 336 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 336 | $437K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 302 | $8K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 302 | $102K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | 1,073 | $468K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 336 | $459K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,073 | — |
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.