| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE WEST | INSURANCE SERVICES LLC 900 EAST HAMILTON AVENUE CAMPBELL, CA 95008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | — | $9K | 5.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 2600 TELEGRAPH RD SUITE 100 BLOOMFIELD HILLS, MI 48302 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 3.04% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 1.44% |
| ACRISURE LLC3 Filed as: ACRISURE WEST | INSURANCE SERVICES LLC 900 EAST HAMILTON AVENUE CAMPBELL, CA 95008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 5.48% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 2600 TELEGRAPH RD SUITE 100 BLOOMFIELD HILLS, MI 48302 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 3.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $583 | $583 | 1.60% |
| ERIC BJORNSON3 | 1150 MORAGA WAY MORAGA, CA 94556 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $9K | — | $9K | 37.18% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SRVCS | 2850 GOLF RD ROLLING MEADOWS, IL 600080008 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $4K | $4K | 15.89% |
| MICHAEL QUINN3 Filed as: MICHAEL E KOPKA | 2600 S TELEGRAPH RD STE 100 BLOOMFIELD MI, MI 48302 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $2K | — | $2K | 9.24% |
| ACRISURE LLC3 Filed as: ACRISURE WEST | INSURANCE SERVICES LLC 3155 OLSEN DR, STE 400 SAN JOSE, CA 95117 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | — | $2K | 9.88% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2600 S TELEGRAPH RD STE 100 BLOOMFIELD HILLS, MI 48302 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $1K | — | $1K | 4.91% |
| ACRISURE LLC3 Filed as: ACRISURE WEST | INSURANCE SERVICES LLC 3155 OLSEN DR, STE 400 SAN JOSE, CA 95117 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | — | $2K | 9.84% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2600 S TELEGRAPH RD STE 100 BLOOMFIELD HILLS, MI 48302 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $1K | — | $1K | 5.07% |
| ACRISURE LLC3 Filed as: ACRISURE WEST | INSURANCE SERVICES LLC 900 EAST HAMILTON AVE CAMPBELL, CA 95008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 5.41% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 2600 TELEGRAPH RD SUITE 100 BLOOMFIELD HILLS, MI 48302 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $658 | — | $658 | 3.09% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 2850 GOLF ROAD GBS FINANCE 5TH FL ROLLING MEADOWS, IL 60008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $306 | $306 | 1.44% |
| ACRISURE LLC3 Filed as: ACRISURE WEST | INSURANCE SERVICES LLC 3155 OLSEN DR, STE 400 SAN JOSE, CA 95117 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | — | $2K | 9.90% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2600 S TELEGRAPH RD STE 100 BLOOMFIELD HILLS, MI 48302 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $858 | — | $858 | 4.79% |
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 | 345 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 37 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 382 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 405 | $25K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 345 | $167K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 66 | $36K |
| Other(4 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 345 | $87K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 405 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.