| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THOMAS DANIEL SNOW JR3 Filed as: THOMAS DANIEL JR SNOW | 300 S FRONT STREET MARQUETTE, MI 498559855 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $73K | — | $73K | 2.75% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA VAST | 100 OTTAWA AVE SW GRAND RAPIDS, MI 495039503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $2K | $2K | 0.07% |
| HEALTH INSURANCE SERVICES3 Filed as: HEALTH INSURANCE SERVICES INC. | SUITE 304 5640 W MAPLE.RD W BLOOMFIELD, MI 483223719 | HUMANA INSURANCE COMPANY | $11K | $58K | $69K | 7.49% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 300 SOUTH FRONT ST MARQUETTE, MI 49855 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $48K | — | $48K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49315 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $22K | — | $22K | 4.61% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $33 | $33 | 0.01% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | DELTA DENTAL OF MICHIGAN | $10K | — | $10K | 4.73% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| STATE STREET BANK AND TRUST EIN 04-1867445 NONE | Trustee (directed); Other fees; Custodial (securities) Service code 19 | — | $37K |
| TOWERS WATSON INVESTMENT SVC INC EIN 52-1868818 NONE | Direct payment from the plan; Investment management fees paid directly by plan; Investment management Service code 28 | — | $24K |
| WILLIS TOWERS WATSON US LLC EIN 53-0181291 NONE | Actuarial; Direct payment from the plan; Consulting (general) Service code 11 | — | $14K |
| CLIFTONLARSONALLEN LLP EIN 41-0746749 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $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 | 176 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 263 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 439 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 600 | $3.6M |
| Dental | DELTA DENTAL OF MICHIGAN | 558 | $209K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 600 | $2.7M |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 329 | $480K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 329 | $480K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 329 | $480K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 600 | $2.7M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 329 | $480K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 600 | — |
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.