| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CSI INSURANCE PLAN AND TRUST FUND4 | 2969 PRAIRIE ST SW, STE 102 GRANDVILLE, MI 494182008 | PRIORITY HEALTH | $196K | — | $196K | 2.57% |
| CSI INSURANCE PLAN AND TRUST FUND4 | 2969 PRAIRIE ST SW, STE 102 GRANDVILLE, MI 494182008 | DELTA DENTAL OF MICHIGAN | $28K | — | $28K | 3.01% |
| CSI INSURANCE PLAN AND TRUST FUND4 | 2969 PRAIRIE ST SW, STE 102 GRANDVILLE, MI 494182008 | HARTFORD LIFE AND ACCIDENT | $21K | — | $21K | 2.91% |
| CSI INSURANCE PLAN AND TRUST FUND4 | 2969 PRAIRIE ST SW, STE 102 GRANDVILLE, MI 494182008 | VISION SERVICE PLAN | $2K | — | $2K | 2.71% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COORDINATED ADMINISTRATIVE SERVICES EIN 38-2716869 NONE KNOWN | Direct payment from the plan; Other services; Contract Administrator; Copying and duplicating; Other fees Service code 13 | — | $256K |
| MERCER, INC. EIN 13-2834414 NONE KNOWN | Consulting (general); Direct payment from the plan Service code 16 | — | $69K |
| LIFEWORKS (US) LTD. EIN 52-1883918 NONE KNOWN | Direct payment from the plan; Other services Service code 49 | — | $68K |
| PLANTE & MORAN PLLC EIN 38-1357951 NONE KNOWN | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $19K |
| SEYFERTHPR NONE KNOWN | Direct payment from the plan; Other services Service code 49 | 40 MONROE CENTER ST NW, #202 GRAND RAPIDS, MI 49503 | $16K |
| WARNER, NORCROSS & JUDD LLP EIN 38-1422647 NONE KNOWN | Legal; Direct payment from the plan Service code 29 | — | $13K |
| 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 | $12K |
| KENT COMMUNICATIONS INC EIN 38-2071291 NONE KNOWN | Other services; Direct payment from the plan Service code 49 | — | $8K |
| ISOLVED BENEFIT SERVICES NONE KNOWN | Direct payment from the plan; Insurance services Service code 23 | PO BOX 889 COLDWATER, MI 49036 | $7K |
| INTL FOUNDATION EE BENEFIT PLAN NONE KNOWN | Other services; Direct payment from the plan Service code 49 | 18700 W BLUEMOUND RD. BROOKFIELD, WI 53045 | $7K |
| GRAF-MARTIN COMMUNICATIONS INC. EIN 81-8283699 NONE KNOWN | Direct payment from the plan; Consulting (general); Other services Service code 16 | — | $5K |
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 | 1,860 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 335 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,195 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PRIORITY HEALTH | 2,080 | $7.6M |
| Dental | DELTA DENTAL OF MICHIGAN | 2,346 | $922K |
| Vision | VISION SERVICE PLAN | 577 | $90K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 2,736 | $706K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 2,736 | $706K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 2,736 | $706K |
| Prescription drug | PRIORITY HEALTH | 2,080 | $7.6M |
| Other | HARTFORD LIFE AND ACCIDENT | 2,736 | $706K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,736 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.