| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 215 N CENTRAL AVE #6 DULUTH, MN 55807 | BLUE CROSS AND BLUE SHIELD OF MINNESOTA | $95K | — | $95K | 3.07% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA HNI RISK SER | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $40K | $2K | $42K | 14.59% |
| SMITH, THOMAS, CHRISTOPHER3 | 798 BERRY RD PO BOX 40386 ALLIS-ROLLER LLC, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $19K | $3K | $22K | 20.23% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC DBA HNI RISK SERVICES | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $14K | $287 | $15K | 13.57% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA HNI RISK SER | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $544 | $11K | 14.66% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC DBA HNI RISK SERVICES | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $10 | $2K | 14.45% |
| SMITH, THOMAS, CHRISTOPHER3 | 798 BERRY RD PO BOX 40386 NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $110 | $1K | 8.12% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA HNI RISK SER | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $919 | $69 | $988 | 10.00% |
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 | 326 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 331 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 493 | $3.1M |
| Dental | BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 493 | $3.1M |
| Vision | BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 493 | $3.1M |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 326 | $105K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 266 | $290K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 266 | $290K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 493 | $3.1M |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 752 | $196K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 752 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
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.