| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE WALLSTREET PARTNERS, LLC | 1530 RAX CT JEFFERSON CIYT, MO 65109 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | $784 | $6K | — |
| ACRISURE LLC3 Filed as: ACRISURE WALLSTREET PARTNERS, LL. | 1530 RAX CT JEFFERSON CITY, MO 65109 | SUN LIFE ASSURANCE COMPANY OF CANADA | $19K | $11K | $31K | — |
| ACRISTURE WALLSTREET PARTNERS, LLC3 | 1530 RAX COURT JEFFERSON CITY, MO 65109 | BLUE CROSS BLUE SHIELD | $3K | — | $3K | — |
| TIFFANY SHELLY3 | 3550 LAKELINE BOULEVARD SUITE 107-1316 LAENDER, TX 78641 | BLUE CROSS BLUE SHIELD | $3K | — | $3K | — |
| ACRISURE LLC3 Filed as: ACRISURE WALLSTREET PARTNERS, L.L.C | 1530 RAX CT JEFFERSON CITY, MO 65109 | SUN LIFE ASSURANCE COMPANY OF CANADA | $17K | — | $17K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD EIN 57-0887419 | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | 2301 MAIN STREET PO BOX 419169 KANSAS CITY, MO 64141 | $91K |
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 | 167 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 167 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD | 103 | $0 |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 172 | $0 |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 172 | $0 |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 172 | $0 |
| Short-term disability(2 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 172 | $0 |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 172 | $0 |
| Prescription drug | BLUE CROSS BLUE SHIELD | 103 | $0 |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 112 | $0 |
| Other(2 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 172 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 172 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.