| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SARAH C HOFFMAN3 | 100 OTTAWA AVE GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $20K | — | $20K | 3.00% |
| SARAH C HOFFMAN3 | 100 OTTAWA AVE GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $13K | — | $13K | 3.00% |
| SARAH C HOFFMAN3 | 100 OTTAWA AVE GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $5K | — | $5K | 3.00% |
| ACRISURE LLC3 | SARAH HOFFMAN 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | DELTA DENTAL OF MICHIGAN | $6K | $139 | $6K | 5.28% |
| ACRISURE LLC3 | SARAH HOFFMAN 500 N WATER ST, STE 900 CORPUS CHRISTI, TX 78401 | DELTA DENTAL OF MICHIGAN | $1K | — | $1K | 1.08% |
| ACRISURE LLC3 | 2176 E CENTRE AVE PORTAGE, MI 49002 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $2K | $6K | 19.50% |
| ACRISURE LLC3 | 2176 E CENTRE AVE PORTAGE, MI 49002 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 16.23% |
| ACRISURE LLC3 | 2176 E CENTRE AVE PORTAGE, MI 49002 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $4K | 16.18% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | EYEMED VISION CARE | $3K | — | $3K | 34.79% |
| JEREMY SAMPSEL3 | 3030 S 9TH ST KALAMAZOO, MI 49009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $142 | $203 | $345 | 5.92% |
| ACRISURE LLC3 | 2163 UNIVERSITY PARK DRIVE OKEMOS, MI 48864 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $306 | $16 | $322 | 5.53% |
| VALUE ADDED SOLUTIONS3 | 1161 HERITAGE CT. SUN PRAIRIE, WI 53590 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $54 | $4 | $58 | 1.00% |
| DIANNA LYNN ATCHISON3 | 225 E DIVISION ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $56 | $1 | $57 | 0.98% |
| DENA ANN MARTHA3 | 225 E DIVISION ST ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $40 | $1 | $41 | 0.70% |
| CORCORAN & HOYT LLC3 | 3905 TAMPA ROAD OLDSMAR, FL 34677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $1 | $3 | 0.05% |
| ACRISURE LLC3 | 2176 E CENTRE AVE PORTAGE, MI 49002 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $499 | $321 | $820 | 16.43% |
| JEREMY SAMPSEL3 | 3030 S 9TH ST KALAMAZOO, MI 49009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $507 | $728 | $1K | 28.51% |
| ACRISURE LLC3 | 2153 UNIVERSITY PARK DRIVE OKEMOS, MI 48864 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $622 | $77 | $699 | 16.14% |
| DENA ANN MARTHA3 | 225 E DIVISION ST ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $297 | $10 | $307 | 7.09% |
| DIANNA LYNN ATCHISON3 | 225 E DIVISION ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $233 | $6 | $239 | 5.52% |
| VALUE ADDED SOLUTIONS3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $32 | $70 | $102 | 2.35% |
| SARAH C HOFFMAN3 | 100 OTTAWA AVE GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $106 | — | $106 | 3.58% |
| ACRISURE LLC3 | 2163 UNIVERSITY PARK DRIVE OKEMOS, MI 48864 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $137 | $6 | $143 | 5.98% |
| JEREMY SAMPSEL3 | 3030 S 9TH ST KALAMAZOO, MI 49009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $38 | $50 | $88 | 3.68% |
| VALUE ADDED SOLUTIONS3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | $5 | $30 | 1.25% |
| DENA ANN MARTHA3 | 225 E DIVISION ST ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | $1 | $25 | 1.04% |
| DIANNA LYNN ATCHISON3 | 225 E DIVISION ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.59% |
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 | 264 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 266 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts) | PRIORITY HEALTH | 198 | $1.3M |
| Dental | DELTA DENTAL OF MICHIGAN | 339 | $118K |
| Vision | EYEMED VISION CARE | 449 | $10K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 224 | $38K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 108 | $32K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 224 | $26K |
| Other(5 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 224 | $51K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 449 | — |
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.