| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TIFFANY GONZALEZ3 | 14860 DUNBARTON PLACE MIAMI LAKES, FL 33016 | TRANSAMERICA LIFE INSURANCE COMPANY | $103K | $0 | $103K | 8.99% |
| EXCELSIOR BENEFITS LLC3 Filed as: EXCELSIOR BENEFITS, LLC. | 23505 SMITHTOWN ROAD, SUITE 200 EXCELSIOR, MN 55331 | TRANSAMERICA LIFE INSURANCE COMPANY | $46K | $0 | $46K | 4.01% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE, INC. | 200 GALLERIA PARKWAY, SUITE 1950 ATLANTA, GA 30339 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $115K | $17K | $132K | 15.31% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC. | 5664 PRAIRIE CREEK DRIVE SE CALEDONIA, MI 49316 | METROPOLITAN LIFE INSURANCE COMPANY | $9K | $0 | $9K | 1.57% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC. | PO BOX 1788 GRAND RAPIDS, MI 49501 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $4K | $4K | 0.72% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC. | 200 NORTH WARNER ROAD, SUITE 450A KING OF PRUSSIA, PA 19406 | VISION SERVICE PLAN | $3K | $0 | $3K | 2.64% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC. | 5664 PRAIRIE CREEK DRIVE SE CALEDONIA, MI 49316 | SAFEGUARD HEALTH PLANS, INC., A FLORIDA CORPORATION | $4K | $0 | $4K | 10.19% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC. | PO BOX 1788 GRAND RAPIDS, MI 49501 | SAFEGUARD HEALTH PLANS, INC., A FLORIDA CORPORATION | $0 | $291 | $291 | 0.74% |
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 | 71 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 72 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | TRANSAMERICA LIFE INSURANCE COMPANY | 71 | $1.9M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 396 | $622K |
| Vision | VISION SERVICE PLAN | 0 | $96K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 0 | $859K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 0 | $859K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 0 | $859K |
| Prescription drug | CIGNA HEALTH & LIFE INSURANCE COMPANY AND AFFILIATES | 71 | $732K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 0 | $859K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 396 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.