| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEATHER A MOSHER3 | 300 S FRONT STREET MARQUETTE, MI 49855 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $53K | — | $53K | 2.17% |
| JULIE ANN FREIDUS3 | 220 S RIDGEWOOD AVE DAYTONA BEACH, FL 32114 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $19K | — | $19K | 0.78% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN AND BROWN INSURANCE SERVICE | 1605 CONCENTRIC BLVD STE 2 SAGINAW, MI 48604 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $2K | $2K | 0.07% |
| ACRISURE LLC3 | PO BOX 2038 GLENVIEW, IL 60025 | GUARDIAN | $24K | — | $24K | 11.43% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN AND BROWN INSURANCE SERVICE | 220 S RIDGEWOOD AVENUE STE 500 DAYTONA BEACH, FL 32114 | GUARDIAN | $7K | — | $7K | 3.37% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN INSURANCE SERVICE | 300 NORTH BEACH STREET DAYTONA BEACH, FL 32114 | GUARDIAN | $1K | $4K | $5K | 2.48% |
| STRATEGIC NON-MEDICAL SOLUTION3 | 75 STATE ST. SUITE 1710 BOSTON, MA 02109 | GUARDIAN | $3K | — | $3K | 1.29% |
| ACRISURE LLC3 Filed as: ACRISURE NJ PARTNERS INS SERVICES | — | GUARDIAN | — | $3K | $3K | 1.27% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN INS SRVCS | 220 S RIDGEWOOD AVE STE 500 DAYTONA BEACH, FL 32114 | GUARDIAN | $143 | — | $143 | 0.07% |
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | DELTA DENTAL OF MICHIGAN | $8K | — | $8K | 4.78% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN INSURANCE | SERVICES, INC. 300 N BEACH ST DAYTONA BEACH, FL 32114 | DELTA DENTAL OF MICHIGAN | $4K | — | $4K | 2.03% |
| ACRISURE LLC3 Filed as: ACRISURE GREAT LAKES PARTNERS | INSURANCE 223 WEST GRAND RIVER AVENUE #1 HOWELL, MI 48843 | EYEMED VISION CARE | $2K | — | $2K | 8.39% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN INSURANCE | SERVICES, INC. P.O. BOX 745961 ATLANTA, GA 30374 | EYEMED VISION CARE | $399 | — | $399 | 1.80% |
| ACRISURE LLC3 Filed as: ACRISURE DBA VAST | — | EYEMED VISION CARE | $209 | — | $209 | 0.95% |
| STRATEGIC NON-MEDICAL SOLUTIONS LLC3 Filed as: STRATEGIC NON-MEDICAL SOLUTIONS | PO BOX 746600 ATLANTA, GA 30374 | EYEMED VISION CARE | $31 | — | $31 | 0.14% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN INS SRVCS, INC | 300 NORTH BEACH ST DAYTONA BEACH, FL 32114 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $877 | $47 | $924 | 7.15% |
| ACRISURE LLC3 Filed as: ACRISURE MIDWEST PARTNERS | INSURANCE SERVICES, LLC 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $725 | — | $725 | 5.61% |
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 | 126 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 130 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 370 | $2.5M |
| Dental | DELTA DENTAL OF MICHIGAN | 369 | $174K |
| Vision | EYEMED VISION CARE | 289 | $22K |
| Life insurance | GUARDIAN | 126 | $212K |
| Short-term disability | GUARDIAN | 126 | $212K |
| Long-term disability | GUARDIAN | 126 | $212K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 370 | $2.5M |
| Other(2 contracts, 2 carriers) | GUARDIAN | 126 | $225K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 370 | — |
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."
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.