| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SARAH C HOFFMAN3 Filed as: SARAH HOFFMAN | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $10K | — | $10K | 4.00% |
| ACRISURE LLC3 | 5411 SKY CENTER DR STE 600 TAMPA, FL 33607 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $333 | $2K | 8.86% |
| ACRISURE LLC3 | 5411 SKY CENTER DR STE 600 TAMPA, FL 33607 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $3K | 16.04% |
| ACRISURE LLC3 | 2965 ALT 19 PALM HARBOR, FL 34683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $450 | $135 | $585 | 13.01% |
| ACRISURE LLC3 | 5411 SKY CENTER DR STE 600 TAMPA, FL 33607 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $421 | $152 | $573 | 13.60% |
| ACRISURE LLC3 | 2965 ALT 19 PALM HARBOR, FL 34683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $407 | $179 | $586 | 14.41% |
| ACRISURE LLC3 | 2965 ALT 19 PALM HARBOR, FL 34683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $597 | $220 | $817 | 20.53% |
| ACRISURE LLC3 | 2965 ALT 19 PALM HARBOR, FL 34683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $386 | $221 | $607 | 15.73% |
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 | 219 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 219 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PRIORITY HEALTH | 48 | $245K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 47 | $18K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 43 | $4K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 30 | $8K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 32 | $17K |
| Other(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 30 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 48 | — |
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.