| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JEFFREY A LEWIS4 | 940 ELMDALE NE GRAND RAPIDS, MI 49525 | PRIORITY HEALTH | $20K | — | $20K | 3.30% |
| LYDIA FARRELL1 | 489 SEMINOLE ROAD MUSKEGON, MI 49444 | PRIORITY HEALTH | $4K | — | $4K | 0.69% |
| JEFFREY A LEWIS3 | 940 ELMDALE NE GRAND RAPIDS, MI 49525 | AMERITAS LIFE INSURANCE CORP. | $2K | — | $2K | 3.89% |
| EMPLOYEE BENEFIT SERVICES4 Filed as: EMPLOYEE BENEFIT SERVICES INC | 489 SEMINOLE ROAD MUSKEGON, MI 49444 | AMERITAS LIFE INSURANCE CORP. | $446 | — | $446 | 0.83% |
| JEFFREY A LEWIS3 | 940 ELMDALE NE GRAND RAPIDS, MI 49525 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 12.26% |
| ACRISURE LLC3 | 489 SEMINOLE ROAD MUSKEGON, MI 49444 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $219 | — | $219 | 1.06% |
| JEFFREY A LEWIS3 | 940 ELMDALE NE GRAND RAPIDS, MI 49525 | PRIORITY HEALTH | $552 | — | $552 | 3.34% |
| LYDIA FARRELL2 | 489 SEMINOLE ROAD MUSKEGON, MI 49444 | PRIORITY HEALTH | $108 | — | $108 | 0.65% |
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 | 151 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 151 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | PRIORITY HEALTH | 149 | $618K |
| Dental(2 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORP. | 195 | $74K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 195 | $54K |
| Life insurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 122 | $21K |
| Prescription drug(3 contracts, 2 carriers) | PRIORITY HEALTH | 149 | $688K |
| Other | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 122 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 195 | — |
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.