| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 127 W MULBERRY ST LANCASTER, OH 43130 | STANDARD INSURANCE COMPANY | $4K | $0 | $4K | 10.92% |
| ACRISURE LLC3 | 127 W MULBERRY ST LANCASTER, OH 43130 | STANDARD INSURANCE COMPANY | $2K | $0 | $2K | 15.51% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAREFACTOR EIN 31-0747539 THIRD PARTY ADMINISTRATOR | Other commissions; Contract Administrator; Insurance brokerage commissions and fees Service code 13 | — | $55K |
| MILLER LEWIS INSURANCE COMPANY EIN 31-1281271 BROKER | Insurance agents and brokers Service code 22 | — | $21K |
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 | 117 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | STANDARD INSURANCE COMPANY | 143 | $40K |
| Long-term disability | STANDARD INSURANCE COMPANY | 36 | $14K |
| Stop-loss / reinsurancereinsurance | U.S. FIRE INSURANCE COMPANY | 117 | $143K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 143 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.