| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | CONTINENTAL AMERICAN INSURANCE COMPANY | $25K | — | $25K | 36.33% |
| ERIC J CONDRON3 | 10880 SANDY OAK TRAIL CEDAR SPRINGS, MI 49319 | CONTINENTAL AMERICAN INSURANCE COMPANY | $20K | — | $20K | 28.82% |
| MIKE S GAYNOR3 | 8672 SHORE WAY DRIVE SW BYRON CENTER, MI 49315 | CONTINENTAL AMERICAN INSURANCE COMPANY | $12 | — | $12 | 0.02% |
| K HARRIS & ASSOCIATES, LLC3 | 950 W. NORTON AVE SUITE 201 MUSKEGON, MI 49441 | CONTINENTAL AMERICAN INSURANCE COMPANY | $6 | — | $6 | 0.01% |
| CAMPBELL FINANCIAL BENEFITS INC3 Filed as: CAMPBELL FINANCIAL BENEFITS, INC. | THE SPROTTE ORGANIZATION PO BOX 1788 GRAND RAPIDS, MI 49501 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.11% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHSCOPE BENEFITS, INC. TPA | Contract Administrator Service code 13 | 27 CORPORATE HILL DRIVE LITTLE ROCK, AR 72205 | $1.2M |
| TOTAL ADMINISTRATIVE SERVICES CORP EIN 39-1561025 TPA | Contract Administrator Service code 13 | — | $22K |
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 | 1,076 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,083 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PRIORITY HEALTH | 0 | $127K |
| Dental | DELTA DENTAL OF MICHIGAN | 1,805 | $642K |
| Vision | VISION SERVICE PLAN | 607 | $112K |
| Life insurance(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 428 | $338K |
| Long-term disability(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 874 | $167K |
| Prescription drug | PRIORITY HEALTH | 0 | $127K |
| Other(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 368 | $236K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,805 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.