| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | COMPANION LIFE INSURANCE COMPANY | $21K | $0 | $21K | 5.08% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $71 | $71 | 0.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ACRISURE LLC EIN 26-3554645 BROKER | Insurance agents and brokers Service code 22 | — | $75K |
| EMPLOYEE BENEFIT MGMT SERVICES LLC EIN 81-0391256 TPA | Contract Administrator Service code 13 | — | $66K |
| AETNA SIGNATURE ADMINISTRATORS EIN 06-6033492 PPO | Other services Service code 49 | — | $19K |
| MAGELLAN RX MANAGEMENT INC EIN 46-3708039 PBM ADMIN | Other services Service code 49 | — | $6K |
| STATE OF ALASKA EIN 92-6001185 VACCINE ASSESSMENT | Other services Service code 49 | — | $5K |
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 | 172 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 173 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 197 | $109K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 197 | $109K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 197 | $109K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE INSURANCE COMPANY | 387 | $416K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 197 | $109K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 387 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.