| 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 | $30K | — | $30K | 2.97% |
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $955 | $955 | 0.10% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA ADVANCED INS AGENC | 28341 HOOVER RD WARREN, MI 48093 | AMERITAS | $9K | — | $9K | 11.67% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | AMERITAS | $4K | — | $4K | 5.00% |
| ACRISURE LLC3 | 1950 CHURCH ST BAKER CITY, OR 97814 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $933 | $7K | 23.22% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 5.00% |
| ACRISURE LLC3 | 1950 CHURCH ST BAKER CITY, OR 97814 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $993 | $7K | 23.44% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 5.00% |
| MARK VANDENBRANDEN3 Filed as: MARK VANDERBRANDEN | 28341 HOVER ROAD WARREN, MI 48093 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $10K | — | $10K | 42.21% |
| THE LOOMIS COMPANY5 | 850 N PARK ROAD WYOMISSING, PA 19610 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $9K | — | $9K | 37.50% |
| ACRISURE LLC3 | 1950 CHURCH ST BAKER CITY, OR 97814 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $525 | $4K | 23.43% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $766 | $766 | 5.00% |
| ACRISURE LLC3 | 1950 CHURCH ST BAKER CITY, OR 97814 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $521 | $4K | 23.49% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $746 | $746 | 5.00% |
| ACRISURE LLC3 | 1950 CHURCH ST BAKER CITY, OR 97814 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $312 | $2K | 23.37% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $463 | $463 | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC DBA ADVANCED INS | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49501 | UNUM INSURANCE COMPANY | $1K | $212 | $2K | 17.44% |
| ACRISURE LLC3 | 1950 CHURCH ST BAKER CITY, OR 97814 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $229 | $2K | 23.23% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $354 | $354 | 5.00% |
| ACRISURE LLC3 | 1950 CHURCH ST BAKER CITY, OR 97814 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $219 | $1K | 23.44% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $318 | $318 | 5.00% |
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 | 156 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 156 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 232 | $1.0M |
| Dental | AMERITAS | 290 | $80K |
| Vision | AMERITAS | 290 | $80K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 156 | $35K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 33 | $29K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 42 | $16K |
| Other(5 contracts, 3 carriers) | FIDELITY SECURITY LIFE INSURANCE COMPANY | 156 | $70K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 290 | — |
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.