| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES R ALTON3 Filed as: JAMES ALTON | 5664 PRAIRIE CREEK DRIVE SE CALEDONIA, MI 49316 | PRIORITY HEALTH | $15K | — | $15K | 1.01% |
| BRENDA R MANNING3 Filed as: BRENDA MANNING | UNKNOWN GRAND RAPIDS, MI 49546 | PRIORITY HEALTH | $14K | — | $14K | 0.98% |
| ACRISURE LLC3 Filed as: ACRISURE | 220 SOUTH WALNUT STREET MUNCIE, IN 47305 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 2.57% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 55 EAST JACKSON BOULEVARD 14TH FLOOR CHICAGO, IL 60604 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 1.32% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $6K | — | $6K | 8.53% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2167 GRAND RAPIDS, MI 49501 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $5K | $103 | $6K | 7.79% |
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 | 251 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 251 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PRIORITY HEALTH | 330 | $1.5M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 133 | $124K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 133 | $124K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 240 | $71K |
| Short-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 240 | $71K |
| Long-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 240 | $71K |
| Prescription drug | PRIORITY HEALTH | 330 | $1.5M |
| Other | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 240 | $71K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.