| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | PO BOX 51187 NEW BERLIN, WI 531510187 | DELTA DENTAL OF WISCONSIN | $5K | — | $5K | 6.15% |
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 495035087 | UNITEDHEALTHCARE INSURANCE COMPANY | $4K | $912 | $5K | 9.36% |
| ACRISURE LLC3 Filed as: HNI RISK SERVICES LLC-ACRISURE LLC | 16805 W CLEVELAND AVENUE NEW BERLIN, WI 53151 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | — | $5K | 15.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $501 | $2K | 6.52% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 495011788 | VISION SERVICE PLAN | $916 | — | $916 | 6.25% |
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 | 149 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 149 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 58 | $55K |
| Dental | DELTA DENTAL OF WISCONSIN | 142 | $86K |
| Vision | VISION SERVICE PLAN | 101 | $15K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 193 | $33K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 193 | $560K |
| 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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.