| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HOWARD VAN MERSBERGEN4 | 3350 E PARIS AVE GRAND RAPIDS, MI 49512 | PRIORITY HEALTH | $175K | — | $175K | 2.36% |
| CSI INSURANCE PLAN AND TRUST FUND3 | 3350 EAST PARIS AVE SE GRAND RAPIDS, ME 49512 | DELTA DENTAL OF MICHIGAN | $18K | — | $18K | 1.82% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | DELTA DENTAL OF MICHIGAN | $12K | — | $12K | 1.17% |
| CSI INSURANCE PLAN AND TRUST FUND3 | 3350 EAST PARIS AVE SE GRAND RAPIDS, MI 49512 | HARTFORD LIFE AND ACCIDENT | $4K | — | $4K | 0.81% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | HARTFORD LIFE AND ACCIDENT | $4K | — | $4K | 0.64% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 606740001 | VISION SERVICE PLAN | $2K | — | $2K | 1.73% |
| CSI INSURANCE PLAN AND TRUST FUND3 | 3350 EAST PARIS AVE SE GRAND RAPIDS, MI 495122907 | VISION SERVICE PLAN | $872 | — | $872 | 0.91% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COORDINATED ADMINISTRATIVE SYSTEM EIN 38-2716869 DIVISION OF PLAN SPONSER | Contract Administrator; Direct payment from the plan; Other fees; Other services; Copying and duplicating Service code 13 | — | $280K |
| MERCER HEALTH & BENEFITS LLC EIN 13-2834414 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $74K |
| MORNEAU SHEPELL SBC LIMITED EIN 45-4303723 NONE | Other services; Direct payment from the plan Service code 49 | — | $62K |
| WARNER, NORCROSS & JUDD EIN 38-1422647 NONE | Legal; Direct payment from the plan Service code 29 | — | $42K |
| PLANTE MORAN PLLC EIN 38-1357951 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $16K |
| NATIONAL INSURANCE PRODUCER REGISTR NONE | Insurance services; Direct payment from the plan Service code 23 | 1100 WALNUT STREET SUITE 1500 KANSAS CITY, MO 64106 | $15K |
| MASCH USA, INC. EIN 38-0695810 NONE | Insurance services; Direct payment from the plan Service code 23 | — | $10K |
| CHRISTIAN SCHOOLS INTERNATIONAL EIN 38-1565440 DIVISION OF PLAN SPONSER | Direct payment from the plan; Other fees Service code 50 | — | $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 | 2,093 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 244 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,337 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PRIORITY HEALTH | 2,068 | $7.4M |
| Dental | DELTA DENTAL OF MICHIGAN | 2,539 | $1.0M |
| Vision | VISION SERVICE PLAN | 655 | $96K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 3,330 | $554K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 3,330 | $554K |
| Prescription drug | PRIORITY HEALTH | 2,068 | $7.4M |
| Other | HARTFORD LIFE AND ACCIDENT | 3,330 | $554K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,330 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.