| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SCOTT M WHITE3 | 300 S FRONT ST MARQUETTE, MI 498559855 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $33K | $0 | $33K | 1.28% |
| THOMAS DANIEL SNOW JR3 Filed as: THOMAS DANIEL JR SNOW | 300 S FRONT STREET MARQUETTE, MI 498559855 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $7K | $0 | $7K | 0.28% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA VAST | 1007 W. HURON WATERFORD, MI 483288328 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $948 | $948 | 0.04% |
| DANIEL M WOLF3 Filed as: DANIEL THOMAS SNOW, JR | 300 S FRONT ST MARQUETTE, MI 49855 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $22K | $22K | 3.52% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 300 SOUTH FRONT ST MARQUETTE, MI 49855 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $46K | $0 | $46K | 10.00% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IL 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $30 | $30 | 0.01% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $5 | $5 | 0.00% |
| CITY INSURANCE AGENCY, INC.3 | 300 FRONT STREET MARQUETTE, MI 49855 | DELTA DENTAL OF MICHIGAN | $10K | — | $10K | 4.73% |
| NATIONAL BENEFIT CONSULTANTS, INC.3 | 208 E. OAK CREST DRIVE WALES, WI 53183 | UNITED AMERICAN INSURANCE COMPANY | $11K | $0 | $11K | 9.53% |
| NATIONAL BENEFIT CONSULTANTS, INC.3 | 208 E. OAK CREST DRIVE WALES, WI 53183 | EXPRESS SCRIPTS, INC | $2K | $0 | $2K | 1.99% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DR. SE CALEDONIA, MI 49316 | EYEMED VISION CARE | $2K | — | $2K | 6.73% |
| CITY INSURANCE AGENCY, INC.3 | 300 FRONT STREET MARQUETTE, MI 49855 | EYEMED VISION CARE | $48 | — | $48 | 0.17% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DR. SE CALEDONIA, MI 49316 | EYEMED VISION CARE | $902 | — | $902 | 18.93% |
| CITY INSURANCE AGENCY, INC.3 | 300 S FRONT ST MARQUETTE, MI 498559855 | EYEMED VISION CARE | $23 | — | $23 | 0.48% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DR. SE CALEDONIA, MI 49316 | EYEMED VISION CARE | $275 | — | $275 | 5.96% |
| CITY INSURANCE AGENCY, INC.3 | 300 S. FRONT STREET MARQUETTE, MI 49855 | EYEMED VISION CARE | $7 | — | $7 | 0.15% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DR. SE CALEDONIA, MI 49316 | EYEMED VISION CARE | $236 | — | $236 | 15.80% |
| CITY INSURANCE AGENCY, INC.3 Filed as: CITY INSURANCE AGENCY | 300 S. FRONT STREET MARQUETTE, MI 49855 | EYEMED VISION CARE | $6 | — | $6 | 0.40% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| STATE STREET BANK AND TRUST EIN 04-1867445 NONE | Trustee (directed); Other fees; Custodial (securities) Service code 19 | — | $44K |
| TOWERS WATSON INVESTMENT SVC INC EIN 52-1868818 NONE | Investment management fees paid directly by plan; Direct payment from the plan; Investment management Service code 28 | — | $25K |
| WILLIS TOWERS WATSON US LLC EIN 53-0181291 NONE | Consulting (general); Actuarial; Direct payment from the plan Service code 11 | — | $14K |
| PRIDE PRINTING NONE | Direct payment from the plan; Other services Service code 49 | 2847 US-41 MARQUETTE, MI 49855 | $6K |
| CLIFTONLARSONALLEN LLP EIN 41-0746749 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $6K |
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 | 172 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 279 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 455 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 532 | $3.3M |
| Dental | DELTA DENTAL OF MICHIGAN | 550 | $209K |
| Vision(4 contracts) | EYEMED VISION CARE | 338 | $39K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 353 | $461K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 353 | $461K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 353 | $461K |
| Prescription drug(3 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 532 | $3.3M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 353 | $461K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 550 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.