| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | UNITEDHEALTHCARE INSURANCE COMPANY | $31K | $2K | $33K | 5.39% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA V&R INS AGENCY | 1507 S ALEXANDER ST STE 101 PLANT CITY, FL 33563 | PRINCIPAL LIFE INSURANCE COMPANY | $13K | — | $13K | 12.39% |
| GIS BENEFITS INC3 | 422 WAUPONSEE ST MORRIS, IL 60450 | PRINCIPAL LIFE INSURANCE COMPANY | $10K | $2K | $12K | 10.95% |
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | PRINCIPAL LIFE INSURANCE COMPANY | — | $440 | $440 | 0.41% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA ALLTRUST INSURANCE | 5411 SKYCENTER DRIVE STE 600 TAMPA, FL 33607 | RELIANCESTANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 20.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCESTANDARD LIFE INSURANCE COMPANY | $851 | $272 | $1K | 6.60% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA ALLTRUST INSURANCE | 5411 SKYCENTER DRIVE STE 600 TAMPA, FL 33607 | RELIANCESTANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 20.00% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCESTANDARD LIFE INSURANCE COMPANY | $625 | $241 | $866 | 6.93% |
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 | 120 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 120 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 126 | $620K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 176 | $107K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 176 | $107K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 176 | $107K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 176 | $107K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 176 | $107K |
| Other(2 contracts) | RELIANCESTANDARD LIFE INSURANCE COMPANY | 45 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 176 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.