| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 2150 SOUTH CENTRAL EXPRESSWAY SUITE 280 MCKINNEY, TX 75070 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $100K | — | $100K | 4.18% |
| ACRISURE LLC3 Filed as: ACRISURE PGM INSURANCE SERVICES LLC | 311 CLOCK TOWER COMMONS BREWSTER, NY 10509 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $0 | $19K | $19K | 0.82% |
| TEPANI INC3 | 420 CLOCK TOWER COMMONS SUITE 311 BREWSTER, NY 10509 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $0 | $14K | $14K | 0.58% |
| GA SOLUTIONS LLC3 | 65 MECHANIC STREET SUITE 106 RED BANK, NJ 07701 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $36K | $5K | $41K | 18.49% |
| BRADLEY K BIEL3 | 225 GRAND ST APT 706 JERSEY CITY, NJ 07302 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $14K | — | $14K | 6.47% |
| WORKSITE WHEELHOUSE3 Filed as: WORKSITE WHEELHOUSE LLC | 103-107 CHURCH ST 3 PHILADELPHIA, PA 19106 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $10K | — | $10K | 4.54% |
| ACRISURE LLC3 Filed as: ACRISURE PGM INSURANCE SERVICES | 311 CLOCK TOWER CMNS BREWSTER, NY 105094059 | PRINCIPAL LIFE INSURANCE COMPANY | $8K | — | $8K | 5.92% |
| GA SOLUTIONS LLC3 | 311 CLOCK TOWER CMNS BREWSTER, NY 105094059 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | $2K | $8K | 5.79% |
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 495011788 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $3K | $3K | 2.32% |
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 | 250 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 259 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 407 | $2.6M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 238 | $140K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 238 | $140K |
| Life insurance(2 contracts, 2 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 292 | $363K |
| Short-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 292 | $223K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 292 | $223K |
| Other | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 292 | $223K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 407 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.