| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 600 SYLVAN AVE STE 301 ENGLEWOOD CLIFFS, NJ 07632 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $4K | $37K | $41K | 4.10% |
| PROFESSIONAL GROUP MARKETING INC3 | 311 CLOCK TWR COMMONS DR BREWSTER, NY 10509 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | — | $21K | $21K | 2.13% |
| TERRY TUTTON3 | 16835 ALGONQUIN ST SUITE 407 HUNTINGTON BEACH, CA 92649 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $4K | — | $4K | 3.15% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1120 BRISTOL ST COSTA MESA, CA 92626 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $209 | $4K | 13.63% |
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 | 103 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 64 | $1.1M |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 64 | $1.0M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 64 | $1.0M |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 103 | $26K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 103 | $26K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 103 | $26K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 103 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.