| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CSI INSURANCE PLAN AND TRUST FUND4 | 3350 EAST PARIS AVE SE GRAND RAPIDS, MI 49512 | PRIORITY HEALTH | $121K | — | $121K | 1.51% |
| CSI INSURANCE PLAN AND TRUST FUND3 | 3350 EAST PARIS AVE SE GRAND RAPIDS, MI 49512 | DELTA DENTAL OF MICHIGAN | $30K | — | $30K | 3.00% |
| CSI INSURANCE PLAN AND TRUST FUND3 | 3350 EAST PARIS AVE SE GRAND RAPIDS, MI 49512 | HARTFORD LIFE AND ACCIDENT | $11K | — | $11K | 2.01% |
| CSI INSURANCE PLAN AND TRUST FUND3 | 3350 EAST PARIS AVE SE GRAND RAPIDS, MI 495122907 | VISION SERVICE PLAN | $3K | — | $3K | 2.36% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COORDINATED ADMINISTRATIVE SERVICES EIN 38-2716869 NONE KNOWN | Other services; Contract Administrator; Other fees; Direct payment from the plan; Copying and duplicating Service code 13 | — | $248K |
| WARNER, NORCROSS & JUDD EIN 38-1422647 NONE KNOWN | Legal; Direct payment from the plan Service code 29 | — | $94K |
| MORNEAU SHEPELL SBC LIMITED EIN 45-4303723 NONE KNOWN | Direct payment from the plan; Other services Service code 49 | — | $74K |
| MERCER HEALTH & BENEFITS LLC EIN 13-2834414 NONE KNOWN | Consulting (general); Direct payment from the plan Service code 16 | — | $47K |
| PLANTE & MORAN PLLC EIN 38-1357951 NONE KNOWN | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $17K |
| MARSH USA, INC. EIN 38-0695810 NONE KNOWN | Insurance services; Direct payment from the plan Service code 23 | — | $11K |
| NATIONAL INSURANCE PRODUCER REGISTR NONE KNOWN | Insurance services; Direct payment from the plan Service code 23 | 1100 WALNUT STREET SUITE 1500 KANSAS CITY, MO 64106 | $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 | 2,420 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 253 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,673 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PRIORITY HEALTH | 2,140 | $8.1M |
| Dental | DELTA DENTAL OF MICHIGAN | 2,597 | $993K |
| Vision | VISION SERVICE PLAN | 607 | $125K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 3,044 | $550K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 3,044 | $550K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 3,044 | $550K |
| Prescription drug | PRIORITY HEALTH | 2,140 | $8.1M |
| Other | HARTFORD LIFE AND ACCIDENT | 3,044 | $550K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,044 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.