| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARK VANDENBRANDEN3 | 28341 HOOVER WARREN, MI 48093 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $73K | $0 | $73K | 1.92% |
| PATRICIA SULLIVAN FORLETTA3 | 30150 TELEGRAPH ROAD, SUITE 408 BINGHAM FARMS, MI 48025 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $15K | $0 | $15K | 0.40% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $4K | $4K | 0.11% |
| JORDON WERTHEIMER3 Filed as: JORDON L. WERTHEIMER | 901 WILSHIRE DRIVE, SUITE 300 TROY, MI 48084 | KANSAS CITY LIFE | $28K | $0 | $28K | 8.19% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | DELTA DENTAL OF MICHIGAN | $12K | $0 | $12K | 3.67% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | DELTA DENTAL OF MICHIGAN | $4K | $0 | $4K | 1.30% |
| MARK VANDENBRANDEN3 | 28341 HOOVER WARREN, MI 48093 | BLUE CARE NETWORK OF MICHIGAN | $4K | $0 | $4K | 1.84% |
| PATRICIA SULLIVAN FORLETTA3 | 30150 TELEGRAPH ROAD, SUITE 408 BINGHAM FARMS, MI 48025 | BLUE CARE NETWORK OF MICHIGAN | $810 | $0 | $810 | 0.39% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | BLUE CARE NETWORK OF MICHIGAN | $0 | $348 | $348 | 0.17% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $7K | $0 | $7K | 10.73% |
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 | 508 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 511 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 785 | $4.0M |
| Dental | DELTA DENTAL OF MICHIGAN | 811 | $332K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 727 | $65K |
| Life insurance | KANSAS CITY LIFE | 509 | $342K |
| Short-term disability | KANSAS CITY LIFE | 509 | $342K |
| Long-term disability | KANSAS CITY LIFE | 509 | $342K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 785 | $4.0M |
| Other | KANSAS CITY LIFE | 509 | $342K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 811 | — |
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."
No prospect flags tripped on this filing.