| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: JMB INSURANCE AGENCY INC | 900 N MICHIGAN AVE 15TH FLOOR CHICAGO, IL 60611 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $93K | $2K | $95K | 3.03% |
| PAUL FLOTKEN3 | 701 MARKET STREET STE 1000 ST LOUIS, MO 63101 | HARVARD PILGRIM HEALTH CARE | $38K | — | $38K | 1.65% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 6255 SUDBURY DRIVE DALLAS, TX 75214 | HARTFORD LIFE AND ACCIDENT | $16K | $60K | $77K | 4.73% |
| PAUL FLOTKEN3 | 701 MARKET STREET SUITE 1000 SAINT LOUIS, MO 63101 | HARVARD PILGRIM HEALTH CARE | $28K | — | $28K | 2.30% |
| ACRISURE LLC7 Filed as: ACRISURE OF CALIFORNIA LLC | 6255 SUDBURY DRIVE DALLAS, TX 75214 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | $58K | $67K | 7.65% |
| PAUL FLOTKEN3 | 701 MARKET STREET STE 1000 ST LOUIS, MO 63101 | HARVARD PILGRIM HEALTH CARE | $4K | — | $4K | 1.61% |
| ACRISURE LLC7 Filed as: ACRISURE OF CALIFORNIA LLC | 6255 SUDBURY DRIVE DALLAS, TX 75214 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $17K | $20K | 7.33% |
| PAUL FLOTKEN3 | 701 MARKET STREET SUITE 1000 SAINT LOUIS, MO 63101 | HARVARD PILGRIM HEALTH CARE | $4K | — | $4K | 3.47% |
| ACRISURE LLC7 Filed as: ACRISURE OF CALIFORNIA LLC | 6255 SUDBURY DRIVE DALLAS, TX 75214 | CIGNA LIFE INSURANCE CO OF NEW YORK | — | $3K | $3K | 6.55% |
| ACRISURE LLC7 Filed as: ACRISURE OF CALIFORNIA LLC | 6255 SUDBURY DRIVE DALLAS, TX 75214 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$54 | -$268 | -$322 | — |
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 | 2,670 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 33 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,703 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(8 contracts, 5 carriers) | HMSA BLUE CROSS BLUE SHIELD OF HAWAII | 4,036 | $29.8M |
| Dental(4 contracts, 2 carriers) | HMSA BLUE CROSS BLUE SHIELD OF HAWAII | 4,036 | $13.7M |
| Vision(2 contracts, 2 carriers) | UNIVERSITY HEALTH ALLIANCE | 8,385 | $5.2M |
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 11,207 | $1.8M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 5,535 | $877K |
| Prescription drug | UNIVERSITY HEALTH ALLIANCE | 964 | $4.7M |
| Other(7 contracts, 6 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 37,166 | $602K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 37,166 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.