| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 300 OTTAWA AVE NW STE 301 GRAND RAPIDS, MI 49503 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $195 | $0 | $195 | 12.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Contract Administrator; Claims processing; Other fees; Direct payment from the plan; Float revenue; Insurance services; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $58K |
| DOUGLAS L DERKS AGENT | Non-monetary compensation; Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | TWO PIERCE PLACE 14TH FL ITASCA, IL 60143 | $10K |
| JAMES R ALTON AGENT | Insurance agents and brokers; Insurance brokerage commissions and fees; Non-monetary compensation; Other commissions Service code 22 | PO BOX 1788 GRAND RAPIDS, MI 49501 | $6K |
| PROFESSIONAL BENEFITS SERVICES TPA | Claims processing Service code 12 | 2959 LUCERNE SE GRAND RAPIDS, MI 49546 | $2K |
| ACRISURE LLC AGENT | Insurance brokerage commissions and fees; Non-monetary compensation; Insurance agents and brokers; Other commissions Service code 22 | DBA CAMPBELL FINANCIAL BENEFITS INC 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | $0 |
| GALLAGHER BENEFIT SERVICES INC AGENT | Non-monetary compensation; Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | 2 PIERCE PLACE ITASCA, IL 60143 | $0 |
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 | 115 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 2 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 120 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 129 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 129 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.