| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROY FARRELL3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $21K | — | $21K | 1.18% |
| ROY FARRELL3 | 489 SEMINOLE ROAD MUSKEGON, MI 49444 | BLUE CARE NETWORK OF MICHIGAN | $25K | — | $25K | 2.80% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | HOMETOWN HEALTH NETWORK | $25K | — | $25K | 4.98% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | BLUE CARE NETWORK OF MICHIGAN | $6K | — | $6K | 1.45% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | BLUE CARE NETWORK OF MICHIGAN | $5K | — | $5K | 1.52% |
| ROY FARRELL3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | LINCOLN FINANCIAL GROUP | $5K | — | $5K | 2.07% |
| ACRISURE LLC3 | 489 SEMINOLD RD MUSKEGON, MI 49444 | LINCOLN FINANCIAL GROUP | $135 | — | $135 | 0.06% |
| ACRISURE LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | DELTA DENTAL PLAN OF MICHIGAN | $4K | — | $4K | 1.80% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE ROAD MUSKEGON, MI 49444 | DELTA DENTAL PLAN OF MICHIGAN | $2K | — | $2K | 0.94% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | BLUE CARE NETWORK OF MICHIGAN | $2K | — | $2K | 1.46% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | BLUE CROSS BLUE SHIELD OF MI | $2K | — | $2K | 2.53% |
| GROTENHUIS | PO BOX 140167 GRAND RAPIDS, MI 49514 | BLUE CROSS BLUE SHIELD OF MI | $418 | — | $418 | 0.45% |
| ROY FARRELL3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | LINCOLN FINANCIAL GROUP | $5K | — | $5K | 6.09% |
| ACRISURE LLC3 Filed as: ACRISURE | 489 SEMINOLD RD MUSKEGON, MI 49444 | LINCOLN FINANCIAL GROUP | $65 | — | $65 | 0.08% |
| EMPLOYEE BENEFIT SERVICES | 489 SEMINOLE RD MUSKEGON, MI 49444 | BLUE CARE NETWORK OF MICHIGAN | $1K | — | $1K | 1.38% |
| BENEFIT PROFILES INC3 | 500 CASCADE W PKWY SE STE 106 GRAND RAPIDS, MI 49546 | DELTA DENTAL OF MICHIGAN | $3K | — | $3K | 3.46% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | DELTA DENTAL OF MICHIGAN | $3K | — | $3K | 3.23% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | DELTA DENTAL OF MICHIGAN | $1K | — | $1K | 1.31% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | BLUE CARE NETWORK OF MICHIGAN | $974 | — | $974 | 1.35% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | NATIONAL VISION ADMINISTRATORS, LLC. | $3K | — | $3K | 10.00% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | NATIONAL VISION ADMINISTRATORS, LLC | $1K | — | $1K | 10.00% |
| EMPLOYEE BENEFIT SERVICES | 489 SEMINOLE RD MUSKEGON, MI 49444 | BLUE CARE NETWORK OF MICHIGAN | $63 | — | $63 | 1.40% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 CONTRACT ADMINISTRATOR | Insurance agents and brokers Service code 22 | — | $399K |
| DELTA DENTAL OF MICHIGAN EIN 38-1791480 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $27K |
| BLUE CROSS BLUE SHIELD OF MI EIN 38-2069753 CONTRACT ADMINISTRATOR | Insurance agents and brokers Service code 22 | — | $17K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(12 contracts, 4 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 257 | $4.6M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL PLAN OF MICHIGAN | 651 | $286K |
| Vision(2 contracts) | NATIONAL VISION ADMINISTRATORS, LLC. | 439 | $38K |
| Life insurance(2 contracts) | LINCOLN FINANCIAL GROUP | 549 | $300K |
| Prescription drug(12 contracts, 4 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 257 | $4.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 651 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.