| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JEFFREY A SCHULTZ3 | 16805 W CLEVELAND AVENUE PO BOX 510187 NEW BERLIN, WI 53151 | PRIORITY HEALTH | $30K | — | $30K | 2.55% |
| DEBRA VANSWEDEN3 | 140 MONROE CENTER ST NW SUITE 200 GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $6K | — | $6K | 0.50% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | DELTA DENTAL OF MICHIGAN | $3K | — | $3K | 2.80% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA HNI RISK SERV | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $223 | $5K | 15.75% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA HNI RISK SER | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $214 | $3K | 11.23% |
| ACRISURE LLC3 | PO BOX 510187 NEW BERLIN, WI 53151 | UNITEDHEALTHCARE INSURANCE COMPANY | $2K | — | $2K | 10.44% |
| JEREMY SAMPSEL3 | 401 HALL ST SW GRAND RAPIDS, MI 49503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $54 | $84 | $138 | 28.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HNDRICKS STUIT INSURANCE A | 3055 44TH ST SW GRANDVILLE, MI 49418 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $56 | $1 | $57 | 11.88% |
| RICHARD LEWIS MULLIGAN3 | 441 HOWARD STREET SE GRAND RAPIDS, MI 49507 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | $8 | $34 | 7.08% |
| DIANNA LYNN ATCHISON3 Filed as: DIANNA LYNEE ATCHISON | 225 E DIVISION ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | $1 | $27 | 5.63% |
| DENA ANN MARTHA3 | 225 E DIVISION ST ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | $1 | $23 | 4.79% |
| KIMBERLY JILL ZBIKOWSKI3 | 1786 DEEPWOOD DR SW WYOMING, MI 49519 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $4 | $6 | 1.25% |
| CYNTHIA SUSANNE EVERY3 | 212 WEST DUNCAN MANCHESTER, MI 48158 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.42% |
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 | 408 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 409 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PRIORITY HEALTH | 193 | $1.2M |
| Dental | DELTA DENTAL OF MICHIGAN | 325 | $96K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 249 | $18K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 408 | $54K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 408 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 408 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.