Form 5500 · Employee benefit plan · BURLINGTON, VT
ACRISURE LLC
The filing calls this plan HICKOK & BOARDMAN LIFE & DISABILITY PLAN.
ACRISURE LLC of BURLINGTON, VT files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is ACRISURE LLC. Coverage is written through UNUM LIFE INSURANCE COMPANY OF AMERICA. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 26-3554645 · plan 505 · plan year 2023, filed Sep 16, 2024
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
Benefits declared on this filing
Also declared: other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 1 insured contract covering life and disability; the largest, with UNUM LIFE INSURANCE COMPANY OF AMERICA, covers 38 people.
Reported premium across the insured contracts is $42,982, with $13,505 in disclosed broker commissions — about 31% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNUM LIFE INSURANCE COMPANY OF AMERICA | Life, Disability | 38 | Jan 1, 2024 | $42,982 | $13,505 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 18,488 employees, 58 recordable cases, 494 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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