| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SARAH C HOFFMAN3 | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | PRIORITY HEALTH | $20K | — | $20K | 3.33% |
| SARAH C HOFFMAN3 | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | PRIORITY HEALTH | $10K | — | $10K | 3.28% |
| SARAH C HOFFMAN3 | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49546 | PRIORITY HEALTH | $6K | — | $6K | 3.26% |
| ACRISURE LLC3 | SARAH HOFFMAN 500 N WATER ST, STE 900 CORPUS CHRISTI, TX 78401 | DELTA DENTAL OF MICHIGAN | $7K | $210 | $7K | 6.31% |
| ACRISURE LLC3 | 2176 E CENTRE AVE PORTAGE, MI 49002 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 15.09% |
| ACRISURE LLC3 | 2176 E CENTRE AVE PORTAGE, MI 49002 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $4K | 14.82% |
| ACRISURE LLC3 | 2176 E CENTRE AVE PORTAGE, MI 49002 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $1K | $5K | 20.51% |
| ACRISURE LLC3 | 2163 UNIVERSITY PARK DRIVE OKEMOS, MI 48864 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $907 | $18 | $925 | 12.21% |
| VALUE ADDED SOLUTIONS3 | 1161 HERITAGE CT. SUN PRAIRIE, WI 53590 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $165 | $234 | $399 | 5.27% |
| JEREMY SAMPSEL3 | 3030 S 9TH ST KALAMAZOO, MI 49009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $46 | $88 | $134 | 1.77% |
| DUSTIN TIMOTHY CONRAD3 | 5605 RAVENS CREST DR PLAINSBORO, NJ 08536 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $69 | — | $69 | 0.91% |
| DENA ANN MARTHA3 | 225 E DIVISION ST ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.36% |
| DIANNA LYNN ATCHISON3 | 225 E DIVISION ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | — | $20 | 0.26% |
| ACRISURE LLC3 | 2176 E CENTRE AVE PORTAGE, MI 49002 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $500 | $268 | $768 | 15.36% |
| DIANNA LYNN ATCHISON3 | 225 E DIVISION ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $675 | $263 | $938 | 32.33% |
| ACRISURE LLC3 | 2163 UNIVERSITY PARK DRIVE OKEMOS, MI 48864 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $413 | $8 | $421 | 14.51% |
| JEREMY SAMPSEL3 | 3030 S 9TH ST KALAMAZOO, MI 49009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $90 | $171 | $261 | 9.00% |
| VALUE ADDED SOLUTIONS3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $57 | $83 | $140 | 4.83% |
| DENA ANN MARTHA3 | 225 E DIVISION ST ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $40 | $1 | $41 | 1.41% |
| DUSTIN TIMOTHY CONRAD3 | 5605 RAVENS CREST DR PLAINSBORO, NJ 08536 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.72% |
| JEREMY SAMPSEL3 | 3030 S 9TH ST KALAMAZOO, MI 49009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $180 | $340 | $520 | 31.53% |
| ACRISURE LLC3 | 2153 UNIVERSITY PARK DRIVE OKEMOS, MI 48864 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $262 | $5 | $267 | 16.19% |
| DENA ANN MARTHA3 | 225 E DIVISION ST ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $115 | — | $115 | 6.97% |
| DIANNA LYNN ATCHISON3 | 225 E DIVISION ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $98 | $2 | $100 | 6.06% |
| VALUE ADDED SOLUTIONS3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $23 | $35 | 2.12% |
| ACRISURE LLC3 | 2176 E CENTRE AVE PORTAGE, MI 49002 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $526 | $526 | 939.29% |
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 | 153 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 156 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts) | PRIORITY HEALTH | 189 | $1.1M |
| Dental | DELTA DENTAL OF MICHIGAN | 313 | $117K |
| Vision | EYEMED VISION CARE | 231 | $12K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 206 | $30K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 93 | $30K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 206 | $25K |
| Other(5 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 206 | $42K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 313 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.