| 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 | $91K | — | $91K | 3.27% |
| ACRISURE LLC3 Filed as: ACRISURE | 100 OTTAWA AVE SW GRAND RAPIDS, MI 495039503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $3K | $3K | 0.10% |
| HEALTH INSURANCE SERVICES3 Filed as: HEALTH INSURANCE SERVICES INC. | SUITE 304 5640 W MAPLE RD W BLOOMFIELD, MI 483223719 | HUMANA INSURANCE COMPANY | $7K | $57K | $64K | 7.04% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 300 SOUTH FRONT ST MARQUETTE, MI 49855 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $49K | — | $49K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49315 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $19K | — | $19K | 3.94% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $34 | $34 | 0.01% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | DELTA DENTAL OF MICHIGAN | $10K | — | $10K | 4.75% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA VAST | 100 OTTAWA AVE SW GRAND RAPIDS, MI 495039503 | MEDICAL AIR SERVICES ASSOCIATION, INC. | $6K | — | $6K | 25.00% |
| MASA AGENT3 | 1250 S PINE ISLAND RD STE 500 PLANTATION, FL 33324 | MEDICAL AIR SERVICES ASSOCIATION, INC. | $1K | — | $1K | 5.30% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| STATE STREET BANK AND TRUST EIN 04-1867445 NONE | Other fees; Trustee (directed); Custodial (securities) Service code 19 | — | $34K |
| TOWERS WATSON INVESTMENT SVC INC EIN 52-1868818 NONE | Direct payment from the plan; Investment management; Investment management fees paid directly by plan Service code 28 | — | $30K |
| WILLIS TOWERS WATSON US LLC EIN 53-0181291 NONE | Direct payment from the plan; Consulting (general); Actuarial Service code 11 | — | $14K |
| CLIFTONLARSONALLEN LLP EIN 41-0746749 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $8K |
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 | 183 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 252 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 435 | 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 | 632 | $3.7M |
| Dental | DELTA DENTAL OF MICHIGAN | 563 | $209K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 632 | $2.8M |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 326 | $488K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 326 | $488K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 326 | $488K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 632 | $2.8M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 326 | $513K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 632 | — |
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.