| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COLDBROOK INSURANCE GROUP3 | JAMES W WATSON 45 COLDBROOK ST GRAND RAPIDS, MI 49503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $10K | $8K | $18K | 6.27% |
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $656 | $656 | 0.23% |
| COLDBROOK INSURANCE GROUP3 Filed as: COLDBROOK INSURANCE GROUP LLC | 45 COLD BROOK ST GRAND RAPIDS, MI 49503 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $18K | — | $18K | 6.83% |
| COLDBROOK INSURANCE GROUP3 Filed as: COLDBROOK INSURANCE GROUP, LLC | 45 COLD BROOK ST NW GRAND RAPIDS, MI 49503 | DELTA DENTAL OF MICHIGAN | $3K | — | $3K | 3.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Contract Administrator; Other fees; Float revenue; Insurance services; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Claims processing Service code 12 | — | $109K |
| COLDBROOK INSURANCE GROUP LLC BROKER | Other fees; Insurance agents and brokers; Insurance brokerage commissions and fees; Non-monetary compensation; Other commissions Service code 22 | 45 COLD BROOK ST GRAND RAPIDS, MI 49503 | $0 |
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 | 139 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 139 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 344 | $289K |
| Dental | DELTA DENTAL OF MICHIGAN | 329 | $98K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 344 | $289K |
| Life insurance(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 116 | $283K |
| Short-term disability(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 116 | $283K |
| Long-term disability(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 116 | $269K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 344 | $289K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 344 | $289K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 344 | — |
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.