| 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 | $98K | $1K | $99K | 3.04% |
| PAUL FLOTKEN3 | 526 CONWAY VILLAGE ST LOUIS, MO 63141 | HARVARD PILGRIM HEALTH CARE | $37K | — | $37K | 1.77% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 318 E CARRUTH LANE DOUBLE OAK, TX 75077 | HARTFORD LIFE AND ACCIDENT | $18K | $47K | $65K | 3.51% |
| PAUL FLOTKEN3 | 526 CONWAY VILLAGE SAINT LOUIS, MO 63141 | HARVARD PILGRIM HEALTH CARE | $26K | — | $26K | 2.21% |
| ACRISURE LLC7 Filed as: ACRISURE OF CALIFORNIA LLC | 318 E CARRUTH LANE DOUBLE OAK, TX 75077 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | $43K | $51K | 6.13% |
| PAUL FLOTKEN3 | 526 CONWAY VILLAGE SAINT LOUIS, MO 63141 | HARVARD PILGRIM HEALTH CARE | $18K | — | $18K | 2.23% |
| PAUL FLOTKEN3 | 526 CONWAY VILLAGE ST LOUIS, MO 63141 | HARVARD PILGRIM HEALTH CARE | $5K | — | $5K | 1.46% |
| ACRISURE LLC7 Filed as: ACRISURE OF CALIFORNIA LLC | 6255 SUDBURY DRIVE DALLAS, TX 75214 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $11K | $13K | 5.82% |
| ACRISURE LLC7 Filed as: ACRISURE OF CALIFORNIA LLC | 318 E CARRUTH LANE DOUBLE OAK, TX 75077 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $36 | $4 | $40 | 0.02% |
| PAUL FLOTKEN3 Filed as: PAUL E FLOTKEN | 526 CONWAY VILLAGE SAINT LOUIS, MO 63141 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $1K | $6K | 3.26% |
| ACRISURE LLC7 Filed as: ACRISURE OF CALIFORNIA LLC | 6255 SUDBURY DRIVE DALLAS, TX 75214 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | — | $4K | $4K | 4.34% |
| ACRISURE LLC7 Filed as: ACRISURE OF CALIFORNIA LLC | 318 E CARRUTH LANE DOUBLE OAK, TX 75077 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | — | $337 | $337 | 0.38% |
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 | 3,452 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 23 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,475 | 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 | 4,640 | $31.2M |
| Dental(5 contracts, 3 carriers) | HMSA BLUE CROSS BLUE SHIELD OF HAWAII | 4,640 | $15.4M |
| Vision(2 contracts, 2 carriers) | UNIVERSITY HEALTH ALLIANCE | 10,327 | $4.9M |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 14,455 | $1.8M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 9,705 | $837K |
| Prescription drug | UNIVERSITY HEALTH ALLIANCE | 1,088 | $4.4M |
| Other(5 contracts, 5 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 39,321 | $435K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 39,321 | — |
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.