| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES R ALTON3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | BLUE CARE NETWORK OF MICHIGAN | $45K | — | $45K | 3.36% |
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $10K | — | $10K | 3.24% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | DELTA DENTAL OF MICHIGAN | $8K | — | $8K | 8.01% |
| ACRISURE LLC3 | 1950 CHURCH ST BALER CITY, OR 97814 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 9.72% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 7.32% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 5.00% |
| ACRISURE LLC3 | 1950 CHURCH ST BAKER CITY, OR 97814 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 11.77% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 7.10% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 5.00% |
| ACRISURE LLC3 | 1950 CHURCH ST BAKER CITY, OR 97814 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 6.71% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 5.00% |
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | EYEMED | $2K | — | $2K | 9.95% |
| ACRISURE LLC3 | 1950 CHURCH ST BAKER CITY, OR 97814 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 7.28% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $710 | $710 | 5.00% |
| ACRISURE LLC3 | 1950 CHURCH ST BAKER CITY, OR 97814 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $571 | $571 | 5.02% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $568 | $568 | 5.00% |
| ACRISURE LLC3 | 5411 SKY CENTER DR STE 600 TAMPA, FL 33607 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $774 | — | $774 | 20.01% |
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 | 121 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 122 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 271 | $1.6M |
| Dental | DELTA DENTAL OF MICHIGAN | 312 | $98K |
| Vision | EYEMED | 284 | $17K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 140 | $41K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 140 | $32K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 140 | $30K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 271 | $1.6M |
| Other(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 140 | $57K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 312 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.