| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | COMPANION LIFE INSURANCE CO | $27K | $0 | $27K | 5.31% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $35 | $35 | 0.03% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $6 | $6 | 0.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFIT MGMT SERVICES LLC EIN 81-0391256 POST-SERVICE NEGOTIATION | Other fees; Contract Administrator Service code 13 | — | $74K |
| AETNA SIGNATURE ADMINISTRATORS EIN 06-6033492 PPO | Other services Service code 49 | — | $21K |
| ACRISURE LLC EIN 26-3554645 BROKER | Insurance agents and brokers Service code 22 | — | $19K |
| COMPSYCH CORPORATION EIN 36-3739783 EAP | Other services Service code 49 | — | $6K |
| MAGELLAN RX MANAGEMENT EIN 46-3708039 PBM ADMIN | Other services Service code 49 | — | $6K |
| STATE OF ALASKA EIN 92-6001185 VACCINE ASSESSMENT | Other services Service code 49 | — | $6K |
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 | 152 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 152 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 208 | $115K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 208 | $115K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 208 | $115K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE INSURANCE CO | 361 | $500K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 208 | $115K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 361 | — |
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."
No prospect flags tripped on this filing.