| 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 | $36K | $870 | $37K | 1.43% |
| MARK VANDENBRANDEN3 | 28341 HOOVER WARREN, MI 48093 | BLUE CARE NETWORK OF MICHIGAN | $5K | $149 | $5K | 1.64% |
| ACRISURE LLC3 | ACRISURE LLC GRAND RAPIDS, MI 49501 | EQUITABLE FINANCIAL INSURANCE COMPANY OF AMERICA | $29K | — | $29K | 11.91% |
| ACRISURE LLC3 | MARK VANDENBRANDEN 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | DELTA DENTAL OF MICHIGAN | $16K | $281 | $16K | 7.61% |
| ACRISURE LLC3 | MARK VANDENBRANDEN 500 N WATER ST, STE 900 CORPUS CHRISTI, TX 78401 | DELTA DENTAL OF MICHIGAN | $5K | — | $5K | 2.33% |
| ACRISURE LLC3 Filed as: ACRISURE DBA | ADVANCED INSURANCE AGENCY INC 28341 HOOVER RD WARREN, MI 48093 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | — | $5K | 21.66% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S GARLAND AVE STE 203 ORLANDO, FL 32801 | METROPOLITAN LIFE INSURANCE COMPANY | — | $284 | $284 | 1.22% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA GARCEAU INSURANCE | AGENCY PO BOX 1788 GRAND RAPIDS, MI 49501 | METROPOLITAN LIFE INSURANCE COMPANY | — | $132 | $132 | 0.57% |
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 | 355 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 357 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 527 | $2.9M |
| Dental | DELTA DENTAL OF MICHIGAN | 596 | $209K |
| Vision | EQUITABLE FINANCIAL INSURANCE COMPANY OF AMERICA | 355 | $240K |
| Life insurance | EQUITABLE FINANCIAL INSURANCE COMPANY OF AMERICA | 355 | $240K |
| Short-term disability | EQUITABLE FINANCIAL INSURANCE COMPANY OF AMERICA | 355 | $240K |
| Long-term disability | EQUITABLE FINANCIAL INSURANCE COMPANY OF AMERICA | 355 | $240K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 596 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.