| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 2965 ALT 19 PALM HARBOR, FL 34683 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8K | $7K | $14K | 11.07% |
| ACRISURE LLC3 | 5664 PRARIE CREEK DR CALEDONIA, MI 27612 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $2K | $7K | 14.09% |
| THE BENEFIT COMPANY INC5 Filed as: THE BENEFIT COMPANY, INC | P.O. BOX 211486 COLUMBIA, SC 29221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 5.00% |
| ALLTRUST INSURANCE3 | 2965 ALT 19 N PALM HARBOR, FL 34683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | -$431 | -$431 | -0.88% |
| ACRISURE LLC3 | 5664 PRARIE CREEK DRIVE SE CALEDONIA, MI 49316 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $1K | $6K | 19.25% |
| THE BENEFIT COMPANY INC5 Filed as: THE BENEFIT COMPANY, INC | PO BOX 211486 COLUMBIA, SC 292216486 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $917 | $917 | 3.00% |
| ALLTRUST INSURANCE3 | 2965 ALT 19 N PALM HARBOR, FL 34683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | -$329 | -$329 | -1.08% |
| ACRISURE LLC3 | 5664 PRARIE CREEK DRIVE CALEDONIA, MI 49316 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 14.17% |
| THE BENEFIT COMPANY INC5 | PO BOX 211486 COLUMBIA, SC 292216486 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $889 | $889 | 3.00% |
| ALLTRUST INSURANCE3 | 2965 ALT 19 N PALM HARBOR, FL 34683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | -$252 | -$252 | -0.85% |
| ACRISURE LLC3 | 5664 PRARIE CREEK DRIVE CALEDONIA, MI 49316 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $1K | $6K | 24.59% |
| ALLTRUST INSURANCE3 | 2965 ALT 19 N PALM HARBOR, FL 34683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | -$280 | -$280 | -1.22% |
| ACRISURE LLC3 | 5664 PRARIE CREEK DRIVE SE CALEDONIA, MI 49316 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $293 | $2K | 22.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE EIN 59-1031071 CLAIMS PROCESSOR | Participant communication; Named fiduciary; Non-monetary compensation; Direct payment from the plan; Float revenue; Other services; Claims processing; Contract Administrator Service code 12 | — | $212K |
| ACRISURE EIN 26-3554645 BROKER | Other commissions Service code 55 | — | $94K |
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 | 513 | 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) | 513 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 260 | $129K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 260 | $129K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 513 | $60K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 71 | $23K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 511 | $49K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE | 306 | $258K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 513 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 513 | — |
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.