| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE | PO BOX 1788 GRAND RAPIDS, MI 49501 | BLUE CARE NETWORK OF MICHIGAN | $21K | — | $21K | 4.89% |
| JAMES R ALTON3 | PO BOX 1788 GRAND RAPIDS, MI 495011788 | BLUE CROSS BLUE SHIELD | $12K | — | $12K | 4.70% |
| GROTENHUIS3 | PO BOX 140167 GRAND RAPIDS, MI 495140167 | BLUE CROSS BLUE SHIELD | $3K | — | $3K | 1.07% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRE CREEK DR SE CALEDONIA, MI 49316 | DELTA DENTAL OF MICHIGAN | $4K | — | $4K | 4.78% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 493168081 | VISION SERVICE PLAN | $718 | — | $718 | 7.67% |
| ACRISURE LLC3 Filed as: ACRISURE DBA THE CAMPBELL GROUP | PO BOX 1788 GRAND RAPIDS, MI 49501 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $218 | $5K | — |
| DWIGHT L PIERCE3 | — | UNUM LIFE INSURANCE COMPANY OF AMERICA | $370 | -$8 | $362 | — |
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 | 159 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 161 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 126 | $686K |
| Dental | DELTA DENTAL OF MICHIGAN | 166 | $79K |
| Vision | VISION SERVICE PLAN | 91 | $9K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 56 | $0 |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 56 | $0 |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 56 | $0 |
| Prescription drug | BLUE CARE NETWORK OF MICHIGAN | 126 | $422K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 56 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 166 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.