| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | DELTA DENTAL PLAN OF MICHIGAN | $6K | — | $6K | 2.72% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 13.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Insurance services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Consulting (general); Direct payment from the plan; Contract Administrator; Float revenue; Other fees Service code 12 | 600 LAFAYETTE EAST DETROIT, MI 48034 | $203K |
| ACRISURE, LLC EIN 26-3554645 AGENT | Other commissions; Other fees; Insurance brokerage commissions and fees; Insurance agents and brokers; Non-monetary compensation Service code 22 | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | $40K |
| EXPRESS SCRIPTS, INC. EIN 22-3461740 RX PROVIDER | Non-monetary compensation Service code 56 | — | $7K |
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 | 359 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 368 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL PLAN OF MICHIGAN | 621 | $235K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 373 | $61K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 621 | — |
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."
No prospect flags tripped on this filing.