| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UNKNOWN3 | UNKNOWN WHITEHALL, AR 71602 | ARKANSAS BLUE CROSS AND BLUE SHIELD | $2K | $10K | $13K | 3.61% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 6100 SOUTH YALE AVENUE, SUITE 1900 TULSA, OK 74136 | 5STAR LIFE INSURANCE COMPANY | $92 | $0 | $92 | 0.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 6100 SOUTH YALE AVENUE, SUITE 1900 TULSA, OK 74136 | UNITEDHEALTHCARE INSURANCE COMPANY | $3K | $0 | $3K | 13.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 1411 OPUS PLACE, SUITE 450 DOWNERS GROVE, IL 60515 | UNITEDHEALTHCARE INSURANCE COMPANY | $0 | $698 | $698 | 3.08% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | UNITEDHEALTHCARE INSURANCE COMPANY | — | $341 | $341 | 1.51% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 17901 GAWTHROP DRIVE, SUITE 104 BRANDENTON, FL 34211 | UNITEDHEALTHCARE INSURANCE COMPANY | — | $304 | $304 | 1.34% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | UNITEDHEALTHCARE INSURANCE COMPANY | $126 | $0 | $126 | 0.56% |
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 | 150 | 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) | 150 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ARKANSAS BLUE CROSS AND BLUE SHIELD | 91 | $347K |
| Dental | ARKANSAS BLUE CROSS AND BLUE SHIELD | 91 | $347K |
| Vision | ARKANSAS BLUE CROSS AND BLUE SHIELD | 69 | $9K |
| Life insurance(2 contracts, 2 carriers) | 5STAR LIFE INSURANCE COMPANY | 88 | $50K |
| Short-term disability | UNITEDHEALTHCARE INSURANCE COMPANY | 88 | $23K |
| Long-term disability | UNITEDHEALTHCARE INSURANCE COMPANY | 88 | $23K |
| Prescription drug | ARKANSAS BLUE CROSS AND BLUE SHIELD | 91 | $347K |
| Other(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 150 | $26K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 150 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.