| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARK VANDENBRANDEN3 Filed as: MARK VANDERBRANDEN | 28341 HOOVER WARREN, MI 48093 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $27K | — | $27K | 2.97% |
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $972 | $972 | 0.11% |
| ACRISURE LLC3 | 28341 HOOVER RD WARREN, MI 48093 | AMERITAS | $8K | — | $8K | 11.69% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | AMERITAS | $3K | — | $3K | 4.31% |
| ACRISURE LLC3 | 691 N SQUIRREL ROAD STE 115 AUBURN HILLS, MI 48326 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $14K | — | $14K | 20.00% |
| THE LOOMIS COMPANY5 | 850 N PARK ROAD WYOMISSING, PA 19610 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $9K | — | $9K | 12.00% |
| ACRISURE LLC3 | 1507 S ALEXANDER ST STE 101 PLANT CITY, FL 33563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 20.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 5.00% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $927 | $927 | 3.26% |
| ACRISURE LLC3 | 1507 S ALEXANDER ST STE 101 PLANT CITY, FL 33563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 20.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 5.00% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $639 | $639 | 2.74% |
| ACRISURE LLC3 | 1507 S ALEXANDER ST STE 101 PLANT CITY, FL 33563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 20.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $743 | $743 | 5.00% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $389 | $389 | 2.62% |
| ACRISURE LLC3 | 1507 S ALEXANDER ST STE 101 PLANT CITY, FL 33563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 20.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $741 | $741 | 5.00% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $352 | $352 | 2.38% |
| ACRISURE LLC3 | 1507 S ALEXANDER ST STE 101 PLANT CITY, FL 33563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 20.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $427 | $427 | 5.00% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $206 | $206 | 2.41% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 20.00% |
| ACRISURE LLC3 | 1507 S ALEXANDER ST STE 101 PLANT CITY, FL 33563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $314 | $314 | 5.00% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $161 | $161 | 2.56% |
| ACRISURE LLC3 | 1507 S ALEXANDER ST STE 101 PLANT CITY, FL 33563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 20.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $306 | $306 | 5.00% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $189 | $189 | 3.09% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA ADVANCED | INSURANCE AGENCY 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $887 | $26 | $913 | 28.63% |
| SMITH, THOMAS, CHRISTOPHER3 | PO BOX 40386 798 BERRY RD NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $128 | — | $128 | 4.01% |
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 | 145 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 145 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 217 | $924K |
| Dental | AMERITAS | 270 | $72K |
| Vision | AMERITAS | 270 | $72K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 145 | $35K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 28 | $23K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 39 | $15K |
| Other(5 contracts, 3 carriers) | FIDELITY SECURITY LIFE INSURANCE COMPANY | 145 | $111K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 270 | — |
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.