| 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 | 3.05% |
| ACRISURE LLC3 Filed as: ACRISURE | 100 OTTAWA AVE SW GRAND RAPIDS, MI 495039503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $2K | $2K | 0.08% |
| HEALTH INSURANCE SERVICES3 Filed as: HEALTH INSURANCE SERVICES INC. | SUITE 206 306 SOUTH WASHINGTON ST ROYAL OAK, MI 480673833 | HUMANA INSURANCE COMPANY | $39K | — | $39K | 6.56% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | CITY INSURANCE AGENCY INC 300 SOUTH FRONT ST MARQUETTE, MI 49855 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $52K | — | $52K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49315 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $20K | — | $20K | 3.81% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $40 | $40 | 0.01% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | DELTA DENTAL OF MICHIGAN | $9K | — | $9K | 4.08% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | DELTA DENTAL OF MICHIGAN | $2K | — | $2K | 0.77% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA VAST | 100 OTTAWA AVE SW GRAND RAPIDS, MI 495039503 | MEDICAL AIR SERVICES ASSOCIATION, INC. | $7K | — | $7K | 37.66% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| STATE STREET BANK AND TRUST EIN 04-1867445 NONE | Custodial (securities); Other fees; Trustee (directed) Service code 19 | — | $35K |
| 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 | — | $31K |
| WILLIS TOWERS WATSON US LLC EIN 53-0181291 NONE | Consulting (general); Direct payment from the plan; Actuarial Service code 11 | — | $16K |
| CLIFTONLARSONALLEN LLP EIN 41-0746749 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $9K |
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 | 192 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 240 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 432 | 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 | 551 | $3.6M |
| Dental | DELTA DENTAL OF MICHIGAN | 586 | $217K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 551 | $3.0M |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 325 | $522K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 325 | $522K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 325 | $522K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 551 | $3.0M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 325 | $541K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 586 | — |
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.