| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | JAMES ALTON 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | PRIORITY HEALTH | $29K | — | $29K | 3.02% |
| ACRISURE LLC3 | 500 N WATER ST, STE 900 CORPUS CHRISTI, TX 78401 | DELTA DENTAL OF MICHIGAN | $2K | — | $2K | 3.99% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | DELTA DENTAL OF MICHIGAN | $206 | $87 | $293 | 0.52% |
| ACRISURE LLC3 | 2965 ALT 19 PALM HARBOR, FL 34683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| ACRISURE LLC3 | 2695 ALT 19 PALM HARBOR, FL 34683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 5.54% |
| KIMBERLY JILL ZBIKOWSKI3 Filed as: KIMBERLY J ZBIKOWSKI | 1786 DEEPWOOD DRIVE SW WYOMING, MI 49519 | CONTINENTAL AMERICAN INSURANCE COMPANY | $386 | — | $386 | 2.04% |
| ERIC J CONDRON3 | 10880 SANDY OAK TRAIL CEDAR SPRINGS, MI 49319 | CONTINENTAL AMERICAN INSURANCE COMPANY | $326 | — | $326 | 1.72% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | CONTINENTAL AMERICAN INSURANCE COMPANY | $282 | — | $282 | 1.49% |
| JOHN TERMEER3 Filed as: JOHN TER MEER | 2620 WINESAP DR NE GRAND RAPIDS, MI 49525 | CONTINENTAL AMERICAN INSURANCE COMPANY | $109 | — | $109 | 0.58% |
| MIKE S GAYNOR3 | 8672 SHORE WAY DR SW BYRON CENTER, MI 60642 | CONTINENTAL AMERICAN INSURANCE COMPANY | $87 | — | $87 | 0.46% |
| SANTIAGO & ASSOCIATES LLC3 | 950 W NORTON SUITE 201 MUSKEGON, MI 49441 | CONTINENTAL AMERICAN INSURANCE COMPANY | $81 | — | $81 | 0.43% |
| K HARRIS & ASSOCIATES, LLC3 Filed as: K HARRIS & ASSOCIATES LLC | 950 W NORTON AVE SUITE 201 MUSKEGON, MI 49441 | CONTINENTAL AMERICAN INSURANCE COMPANY | $80 | — | $80 | 0.42% |
| BRUCE A VAN RYN3 | 3053 RIVERVALE DRIVE SW GRANDVILLE, MI 49418 | CONTINENTAL AMERICAN INSURANCE COMPANY | $26 | — | $26 | 0.14% |
| WILLIAM JOHNSON & ASSOC LLC3 | 1755 INDIAN LAKE CEDAR SPRINGS, MI 49319 | CONTINENTAL AMERICAN INSURANCE COMPANY | $18 | — | $18 | 0.10% |
| ACRISURE LLC3 | 2176 E CENTRE AVE PORTAGE, MI 49002 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| ACRISURE LLC3 | 2176 E CENTRE AVE PORTAGE, MI 49002 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 6.48% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | VISION SERVICE PLAN | $816 | — | $816 | 7.54% |
| ACRISURE LLC3 | 2965 ALT 19 PALM HARBOR, FL 34683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $333 | — | $333 | 10.01% |
| ACRISURE LLC3 | 2965 ALT 19 PALM HARBOR, FL 34683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $186 | $186 | 5.59% |
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 | 104 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 104 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PRIORITY HEALTH | 179 | $973K |
| Dental | DELTA DENTAL OF MICHIGAN | 182 | $57K |
| Vision | VISION SERVICE PLAN | 84 | $11K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 117 | $30K |
| Short-term disability | CONTINENTAL AMERICAN INSURANCE COMPANY | 157 | $19K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 96 | $18K |
| Prescription drug | PRIORITY HEALTH | 179 | $973K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 157 | $49K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 182 | — |
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.