| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 2001 MARCUS AVE LAKE SUCCESS, NY 11042 | SUN LIFE ASSURANCE COMPANY OF CANADA | $79K | $0 | $79K | 13.11% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | UNITED HEALTHCARE INSURANCE COMPANY | $63K | $0 | $63K | 10.65% |
| ACRISURE LLC3 | 2965 ALT 19 N PALM HARBOR, FL 34683 | UNITED HEALTHCARE INSURANCE COMPANY | $0 | $27K | $27K | 4.53% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 17901 GAWTHROP DRIVE UNIT 104 BRANDENTON, FL 34211 | UNITED HEALTHCARE INSURANCE COMPANY | $0 | $8K | $8K | 1.29% |
| ACRISURE LLC3 Filed as: ACRISURE | 2001 MARCUS AVE LAKE SUCCESS, NY 11042 | SUN LIFE ASSURANCE COMPANY OF CANADA | $21K | $0 | $21K | 15.45% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MO 49546 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $5K | $5K | 3.64% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $580K |
| ADMIN AMERICA, INC. FSA ADMIN | Claims processing Service code 12 | 1720 WINDWARD CONCOURSE SUITE 290 ALPHARETTA, GA 30005 | $15K |
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 | 1,263 | 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) | 1,263 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED HEALTHCARE INSURANCE COMPANY | 1,782 | $595K |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 1,782 | $595K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,263 | $600K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,263 | $600K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,263 | $600K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE INSURANCE COMPANY | 1,169 | $1.1M |
| Other(2 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,263 | $733K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,782 | — |
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.