| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SARAH C HOFFMAN3 | 100 OTTAWA AVE GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $19K | — | $19K | 3.00% |
| SARAH C HOFFMAN3 | 100 OTTAWA AVE GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $15K | — | $15K | 3.00% |
| SARAH C HOFFMAN3 | 100 OTTAWA AVE GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $6K | — | $6K | 3.00% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | DELTA DENTAL OF MICHIGAN | $7K | — | $7K | 4.81% |
| SARAH C HOFFMAN3 | 100 OTTAWA AVE GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $4K | — | $4K | 3.00% |
| ACRISURE LLC3 | 2176 E CENTRE AVE PORTAGE, MI 49002 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $294 | $4K | 8.55% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 5.00% |
| ACRISURE LLC3 | 2176 E CENTRE AVE PORTAGE, MI 49002 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $259 | $5K | 14.79% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 5.00% |
| ACRISURE LLC3 | 2176 E CENTRE AVE PORTAGE, MI 49002 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $252 | $4K | 10.74% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | EYEMED VISION CARE | $2K | — | $2K | 9.62% |
| ACRISURE LLC3 | 2176 E CENTRE AVE PORTAGE, MI 49002 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $587 | $50 | $637 | 10.86% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $293 | $293 | 4.99% |
| JEREMY SAMPSEL3 | 3030 S 9TH ST KALAMAZOO, MI 49009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $179 | $253 | $432 | 7.65% |
| ACRISURE LLC3 | 2163 UNIVERSITY PARK DRIVE OKEMOS, MI 48864 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $356 | $64 | $420 | 7.44% |
| DIANNA LYNN ATCHISON3 | 225 E DIVISION ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $75 | $10 | $85 | 1.51% |
| DENA ANN MARTHA3 | 225 E DIVISION ST ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $80 | $1 | $81 | 1.43% |
| VALUE ADDED SOLUTIONS3 | 1161 HERITAGE CT. SUN PRAIRIE, WI 53590 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $45 | — | $45 | 0.80% |
| CORCORAN & HOYT LLC3 | 3905 TAMPA ROAD OLDSMAR, FL 34677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $2 | $7 | 0.12% |
| JEREMY SAMPSEL3 | 3030 S 9TH ST KALAMAZOO, MI 49009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $279 | $293 | $572 | 11.89% |
| ACRISURE LLC3 | 2153 UNIVERSITY PARK DRIVE OKEMOS, MI 48864 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $324 | $68 | $392 | 8.15% |
| DIANNA LYNN ATCHISON3 | 225 E DIVISION ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $157 | $16 | $173 | 3.60% |
| DENA ANN MARTHA3 | 225 E DIVISION ST ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $110 | $1 | $111 | 2.31% |
| VALUE ADDED SOLUTIONS3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $30 | $9 | $39 | 0.81% |
| CORCORAN & HOYT LLC3 | 3905 TAMPA ROAD OLDSMAR, FL 34677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $1 | $3 | 0.06% |
| ACRISURE LLC3 | 2163 UNIVERSITY PARK DRIVE OKEMOS, MI 48864 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $99 | $5 | $104 | 4.38% |
| JEREMY SAMPSEL3 | 3030 S 9TH ST KALAMAZOO, MI 49009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | $18 | $41 | 1.73% |
| VALUE ADDED SOLUTIONS3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | $2 | $26 | 1.09% |
| DIANNA LYNN ATCHISON3 | 225 E DIVISION ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $1 | $13 | 0.55% |
| DENA ANN MARTHA3 | 225 E DIVISION ST ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.51% |
| JEREMY SAMPSEL3 | 401 HALL ST SW GRAND RAPIDS, MI 49503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $51 | $92 | $143 | 43.87% |
| ACRISURE LLC3 | 2163 UNIVERSITY PARK DRIVE OKEMOS, MI 48864 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $67 | $25 | $92 | 28.22% |
| DENA ANN MARTHA3 | 225 E DIVISION ST ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $32 | — | $32 | 9.82% |
| DIANNA LYNN ATCHISON3 | 225 E DIVISION ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | $4 | $24 | 7.36% |
| CORCORAN & HOYT LLC3 | 3905 TAMPA ROAD OLDSMAR, FL 34677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $1 | $2 | 0.61% |
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 | 236 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 240 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts) | PRIORITY HEALTH | 191 | $1.5M |
| Dental | DELTA DENTAL OF MICHIGAN | 370 | $141K |
| Vision | EYEMED VISION CARE | 263 | $22K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 241 | $41K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 128 | $50K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 241 | $34K |
| Other(6 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 241 | $55K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 370 | — |
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.