| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES R ALTON3 Filed as: JAMES ALTON | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | PRIORITY HEALTH | $30K | — | $30K | 1.98% |
| ACRISURE LLC3 | 220 SOUTH WALNUT ST MUNCIE, IN 47305 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 4.04% |
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $11K | $101 | $12K | 16.18% |
| JAMES R ALTON3 Filed as: JAMES ALTON | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | PRIORITY HEALTH | $400 | — | $400 | 1.99% |
| JOY A RYBICKI3 Filed as: JOY RYBICKI | 71-129TH AVE WAYLAND, MI 49348 | AFLAC | $1K | — | $1K | 8.28% |
| EOWALTERS LLC3 | PO BOX 150199 GRAND RAPIDS, MI 49515 | AFLAC | $137 | — | $137 | 0.96% |
| JANET KIDDER3 | 2870 PORTER ST SW GRANDVILLE, MI 49418 | AFLAC | $136 | — | $136 | 0.96% |
| WILLIAM JOHNSON & ASSOC LLC3 | 17276 VIOLET RUTH DR NE CEDAR SPRINGS, MI 49319 | AFLAC | $135 | — | $135 | 0.95% |
| JEFFRY D DEKAM3 | 3185 MACATAWA DR SW STE D GRANDVILLE, MI 49418 | AFLAC | $96 | — | $96 | 0.67% |
| ANDREW K GLAUB3 | 2150 ASSOCIATION DRIVE SUITE 150 OKEMOS, MI 48864 | AFLAC | $65 | — | $65 | 0.46% |
| NORTHERN BENEFITS NETWORK3 | PO BOX 140167 GRAND RAPIDS, MI 49514 | AFLAC | $47 | — | $47 | 0.33% |
| JEREMY D SAMPSEL3 | 3030 S 9TH ST STE 2K KALAMAZOO, MI 49009 | AFLAC | $45 | — | $45 | 0.32% |
| WILLIAM A DIX3 | 163 N DIVISION AVE HOLLAND, MI 49424 | AFLAC | $32 | — | $32 | 0.22% |
| ANNA LORELEI WIERENGA3 | 12860 VALLEY DRIVE WAYLAND, MI 49348 | AFLAC | $21 | — | $21 | 0.15% |
| MERRI C SMITH3 | 492 142ND AVE CALEDONIA, MI 49316 | AFLAC | $21 | — | $21 | 0.15% |
| CHARLES V GLAUB3 | 5458 PARKSIDE BRIGHTON, MI 48114 | AFLAC | $19 | — | $19 | 0.13% |
| AG AND ASSOCIATES3 | 2150 ASSOCIATION DR STE 150 OKEMOS, MI 48864 | AFLAC | $15 | — | $15 | 0.11% |
| WESTERN WAVE LLC3 | 2039 RAMBLING OAK DR MUSKEGON, MI 49445 | AFLAC | $14 | — | $14 | 0.10% |
| MYRNA L MURRAY3 | 2114 BOSTON BLVD STE 2 LANSING, MI 48910 | AFLAC | $14 | — | $14 | 0.10% |
| TERESA M SANDERS3 | 1252 TIMBER OAKS CT PLAINWELL, MI 49080 | AFLAC | $14 | — | $14 | 0.10% |
| MARY EVELYN LEGGETT3 Filed as: MARY E LEGGETT | 522 MAPLE ST ALLEGAN, MI 49010 | AFLAC | $13 | — | $13 | 0.09% |
| JASON SCZEPANIAK3 | 4001 FELLAND ROAD STE 106 MADISON, WI 53718 | AFLAC | $9 | — | $9 | 0.06% |
| WESLEY A SMITH3 | 9125 COSTNER DR SE CALEDONIA, MI 49316 | AFLAC | $6 | — | $6 | 0.04% |
| RANDALL L KIMBLER3 | PO BOX 302 HESPERIA, MI 49421 | AFLAC | $6 | — | $6 | 0.04% |
| JAMES C SNIDER JR3 | 2461 W STATE ROAD 426 STE 2061 OVIEDO, FL 32765 | AFLAC | $5 | — | $5 | 0.04% |
| RICHARD L MULLIGAN3 | 3680 CAMELOT DR SE APT 2A GRAND RAPIDS, MI 49456 | AFLAC | $3 | — | $3 | 0.02% |
| JEFFREY C WERNER3 Filed as: JEFFREY WERNER LLC | 18096 TRUDY DR SPRING LAKE, MI 49456 | AFLAC | $1 | — | $1 | 0.01% |
No Schedule C service providers reported on this filing.
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 | 224 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 225 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | PRIORITY HEALTH | 339 | $1.5M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $119K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $119K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 289 | $71K |
| Short-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 289 | $71K |
| Long-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 289 | $71K |
| Prescription drug(2 contracts) | PRIORITY HEALTH | 339 | $1.5M |
| Other(2 contracts, 2 carriers) | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 289 | $86K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 339 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.