| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 1821 WALDEN OFFICE SQ, SUITE 350 SCHAUMBURG, IL 60173 | PRINCIPAL LIFE INSURANCE COMPANY | $30K | — | $30K | 8.12% |
| GA SOLUTIONS LLC3 Filed as: GA SOLUTIONS, LLC | 311 CLOCK TOWER COMMONS BREWSTER, NY 10509 | PRINCIPAL LIFE INSURANCE COMPANY | — | $16K | $16K | 4.38% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | PRINCIPAL LIFE INSURANCE COMPANY | — | $2K | $2K | 0.56% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 1821 WALDEN OFFICE SQUARE SUITE 350 SCHAUMBURG, IL 60173 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $1K | — | $1K | 4.22% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 1821 WALDEN OFFICE SQ, SUITE 350 SCHAUMBURG, IL 60173 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 15.12% |
| REBECCA STERNBERG3 | 374 MILFORD ROAD DEERFIELD, IL 60015 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $30 | $0 | $30 | 0.40% |
| MICHAEL BLOCK3 | 41 ARUM COURT ST AUGUSTINE, FL 32095 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $18 | $0 | $18 | 0.24% |
| SANTIAGO OCHOA3 | 3605 SOUTH LOMBARD AVENUE CICERO, IL 60804 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4 | $0 | $4 | 0.05% |
| ROSALINDA BENTANCUR RODRIGUEZ3 | 2035 ALTA VISTA STREET HOUSTON, TX 77023 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4 | $0 | $4 | 0.05% |
| ERNESTO ELOY GARCIA3 | 1244 WILSON DRIVE LANTANA, TX 76226 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.03% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 1821 WALDEN OFFICE SQ, SUITE 350 SCHAUMBURG, IL 60173 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $590 | $0 | $590 | 14.00% |
| REBECCA STERNBERG3 | 374 MILFORD ROAD DEERFIELD, IL 60015 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $16 | $0 | $16 | 0.38% |
| MICHAEL BLOCK3 | 41 ARUM COURT ST AUGUSTINE, FL 32095 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $7 | $0 | $7 | 0.17% |
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 | 381 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 381 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 565 | $372K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 385 | $33K |
| Life insurance(3 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 565 | $383K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 565 | $372K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 565 | $372K |
| Other(3 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 565 | $383K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 565 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.