| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES R ALTON3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | BLUE CARE NETWORK OF MICHIGAN | $1K | — | $1K | 0.08% |
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $408 | — | $408 | 0.07% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | DELTA DENTAL OF MICHIGAN | $8K | — | $8K | 8.10% |
| ACRISURE LLC3 | 1201 TOWN PARK LN EVANS, GA 30809 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 9.52% |
| ACRISURE LLC3 | 2965 ALT 19 PALM HARBOR, FL 34683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 5.60% |
| ACRISURE LLC3 | 1201 TOWN PARK LN EVANS, GA 30809 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 11.67% |
| ACRISURE LLC3 | 2965 ALT 19 PALM HARBOR, FL 34683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 5.91% |
| ACRISURE LLC3 | 1201 TOWN PARK LN EVANS, GA 30809 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| ACRISURE LLC3 | 2965 ALT 19 PALM HARBOR, FL 34683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 5.94% |
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | EYEMED | $2K | — | $2K | 10.17% |
| ACRISURE LLC3 | 1201 TOWN PARK LN EVANS, GA 30809 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| ACRISURE LLC3 | 2965 ALT 19 PALM HARBOR, FL 34683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $931 | $931 | 6.30% |
| ACRISURE LLC3 | 1201 TOWN PARK LN EVANS, GA 30809 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
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 | 1 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 0 | $2.3M |
| Dental | DELTA DENTAL OF MICHIGAN | 340 | $99K |
| Vision | EYEMED | 0 | $19K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $41K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $33K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 144 | $30K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 0 | $2.3M |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 34 | $52K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 340 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.