| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRICIA CLINE3 | 444 WEST MICHIGAN AVENUE KALAMAZOO, MI 49007 | PHYSICIANS HEALTH PLAN | $32K | — | $32K | 2.06% |
| BRIAN BELLWARE3 | 202 S. MICHIGAN ST. STE 1400 SOUTH BEND, IN 46601 | PHYSICIANS HEALTH PLAN | $15K | — | $15K | 0.94% |
| PATRICIA CLINE3 | 444 WEST MICHIGAN AVENUE KALAMAZOO, MI 49007 | PHP INSURANCE COMPANY | $7K | — | $7K | 2.06% |
| BRIAN BELLWARE3 | 202 S. MICHIGAN ST. STE 1400 SOUTH BEND, IN 46601 | PHP INSURANCE COMPANY | $3K | — | $3K | 0.94% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | DELTA DENTAL OF MICHIGAN | $1K | $237 | $1K | 1.60% |
| GIBSON INSURANCE AGENCY, INC.3 | 130 S MAIN ST #400 SOUTH BEND, IN 46601 | DELTA DENTAL OF MICHIGAN | $1K | — | $1K | 1.27% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 500 N WATER ST STE 900 CORPUS CHRISTI, TX 78401 | DELTA DENTAL OF MICHIGAN | $584 | — | $584 | 0.66% |
| ACRISURE LLC3 | 444 WEST MICHIGAN AVENUE KALAMAZOO, MI 49007 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $4K | $10K | 12.63% |
| GIBSON INSURANCE AGENCY, INC.3 | PO BOX 11177 SOUTH BEND, MI 46634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 2.39% |
| ACRISURE LLC3 | 444 WEST MICHIGAN AVENUE KALAMAZOO, MI 49007 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $3K | $7K | 10.04% |
| GIBSON INSURANCE AGENCY, INC.3 | PO BOX 11177 SOUTH BEND, MI 46634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $920 | — | $920 | 1.39% |
| ACRISURE LLC3 | 444 WEST MICHIGAN AVENUE KALAMAZOO, MI 49007 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $6K | 12.06% |
| GIBSON INSURANCE AGENCY, INC.3 | PO BOX 11177 SOUTH BEND, MI 46634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $963 | — | $963 | 2.03% |
| ACRISURE LLC3 | 444 WEST MICHIGAN AVENUE KALAMAZOO, MI 49007 | VISION SERVICE PLAN | $974 | — | $974 | 4.10% |
| GIBSON INSURANCE AGENCY, INC.3 | 202 S. MICHIGAN ST. STE 1400 SOUTH BEND, IN 46601 | VISION SERVICE PLAN | $248 | — | $248 | 1.04% |
| ACRISURE LLC3 | 444 WEST MICHIGAN AVENUE KALAMAZOO, MI 49007 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $1K | $2K | 10.53% |
| GIBSON INSURANCE AGENCY, INC.3 | PO BOX 11177 SOUTH BEND, MI 46634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $924 | — | $924 | 4.08% |
| ACRISURE LLC3 | 444 WEST MICHIGAN AVENUE KALAMAZOO, MI 49007 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $967 | $2K | 10.46% |
| GIBSON INSURANCE AGENCY, INC.3 | PO BOX 11177 SOUTH BEND, MI 46634 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $867 | — | $867 | 3.94% |
| ACRISURE LLC3 | 444 WEST MICHIGAN AVENUE KALAMAZOO, MI 49007 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $222 | $182 | $404 | 10.97% |
| GIBSON INSURANCE AGENCY, INC.3 | PO BOX 11177 SOUTH BEND, MI 46634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $146 | — | $146 | 3.97% |
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 | 238 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 238 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PHYSICIANS HEALTH PLAN | 316 | $1.9M |
| Dental | DELTA DENTAL OF MICHIGAN | 414 | $88K |
| Vision | VISION SERVICE PLAN | 216 | $24K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 238 | $83K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 180 | $66K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 238 | $48K |
| Prescription drug(2 contracts, 2 carriers) | PHYSICIANS HEALTH PLAN | 316 | $1.9M |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 238 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 414 | — |
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.