| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARK VANDENBRANDEN3 | 28341 HOOVER WARREN, MI 48093 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $28K | $0 | $28K | 3.26% |
| ACRISURE LLC | 100 PASSAIC AVE. SUITE 120 FAIRFIELD, NJ 07004 | NATIONWIDE SPECIALTY INSURANCE COMPANY | — | $17K | $17K | 15.00% |
| ACRISURE LLC | 28341 HOOVER RD WARREN, MI 48093 | ACRISURE LLC | $8K | $1K | $9K | 13.69% |
| ACRISURE LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $235 | $2K | 17.18% |
| ACRISURE LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $125 | $1K | 19.56% |
| ACRISURE LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $797 | — | $797 | 22.68% |
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 | 108 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 108 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 181 | $844K |
| Dental | ACRISURE LLC | 428 | $68K |
| Vision | ACRISURE LLC | 428 | $68K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 118 | $7K |
| Long-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 118 | $10K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 181 | $844K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 118 | $20K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 428 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.