| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EMPLOYERS INSURANCE GROUP INC3 Filed as: EMPLOYERS INSURANCE AGENCY | 17272 ROBBINS ROAD SUITE B GRAND HAVEN, MI 49417 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | — | $5K | — |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 30150 TELEGRAPH RD STE 408 BINGHAM FARMS, MI 48025 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | — |
| EMPLOYERS INSURANCE GROUP INC3 Filed as: EMPLOYERS INSURANCE AGENCY | 17272 ROBBINS ROAD SUITE B GRAND HAVEN, MI 49417 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | — | $4K | — |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFIT SERVICES, INC | 30150 TELEGRAPH RD STE 408 BINGHAM FARMS, MI 48025 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | — |
| WESTERN WAVE LLC | 2039 RAMBLING OAK DRIVE MUSKEGON, MI 49445 | CONTINENTAL AMERICAN INSURANCE COMPANY | $6K | — | $6K | — |
| BRUCE A VAN RYN3 Filed as: BRUCE VANRYN | 3053 RIVERVALE DRIVE SOUTHWEST ST GRANDVILLE, MI 49418 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | — | $1K | — |
| ERIC J CONDRON3 | 10880 SANDY OAK TRAIL CEDAR SPRINGS, MI 49319 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | — | $1K | — |
| CONDRONERICJ3 | 10880 SANDY OAK TRAIL CEDAR SPRINGS, MI 49319 | CONTINENTAL AMERICAN INSURANCE COMPANY | $884 | — | $884 | — |
| JEFFREY C WERNER3 | 18096 TRUDY DR SPRING LAKE, MI 49456 | CONTINENTAL AMERICAN INSURANCE COMPANY | $300 | — | $300 | — |
| AG AND ASSOCIATES3 | 2150 ASSOCIATION DR STE 150 OKEMOS, MI 48864 | CONTINENTAL AMERICAN INSURANCE COMPANY | $255 | — | $255 | — |
| HEATHER DOLLIVER3 | 212 W SILVER LK ROAD FENTON, MI 48430 | CONTINENTAL AMERICAN INSURANCE COMPANY | $77 | — | $77 | — |
| STEPHANIE L KESSELRING3 Filed as: STEPHANIE KESSELRING | 3141 ROLLING GREEN CT MILFORD, MI 48380 | CONTINENTAL AMERICAN INSURANCE COMPANY | $72 | — | $72 | — |
| CHRIS BOULDREY3 | 340 WOOD HILLS DRIVE CONCORD, MI 49237 | CONTINENTAL AMERICAN INSURANCE COMPANY | $39 | — | $39 | — |
| THE JAMES B OSWALD COMPANY3 Filed as: JAMES SNIDER | 830 JUANITA RAEL WINTER PARK, FL 32789 | CONTINENTAL AMERICAN INSURANCE COMPANY | $39 | — | $39 | — |
| JIM M BULLOCK3 Filed as: JIM BULLOCK | 3715 POWDERHORN DR OKEMOS, MI 48864 | CONTINENTAL AMERICAN INSURANCE COMPANY | $29 | — | $29 | — |
| JEFFREY C WERNER3 Filed as: JEFFREY WERNER | 18096 TRUDY DR SPRING LAKE, MI 49456 | CONTINENTAL AMERICAN INSURANCE COMPANY | $25 | — | $25 | — |
| AG AND ASSOCIATES3 | 2150 ASSOCIATION DRIVE STE 150 OKEMOS, MI 48864 | CONTINENTAL AMERICAN INSURANCE COMPANY | $24 | — | $24 | — |
| AG AND ASSOCIATES3 | 2150 ASSOCIATION DRIVE STE 150 OKEMOS, MI 48864 | CONTINENTAL AMERICAN INSURANCE COMPANY | $21 | — | $21 | — |
| JULIE SLAUGHTER3 | 430 BOARDWALK WALLED LAKE, MI 48390 | CONTINENTAL AMERICAN INSURANCE COMPANY | $3 | — | $3 | — |
| BRIAN FALKOWSKI3 | 17272 ROBBINS RD GRAND HAVEN, MI 49417 | PRIORITY HEALTH | $33K | — | $33K | — |
| EMPLOYERS INSURANCE GROUP INC3 Filed as: EMPLOYERS INSURANCE AGENCY | 17272 ROBBINS ROAD SUITE B GRAND HAVEN, MI 49417 | RELIANCE STANDARD INSURANCE COMPANY | $5K | — | $5K | — |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 30150 TELEGRAPH RD STE 408 BINGHAM FARMS, MI 48025 | RELIANCE STANDARD INSURANCE COMPANY | $1K | — | $1K | — |
| EMPLOYERS INSURANCE GROUP INC3 Filed as: EMPLOYERS INSURANCE AGENCY | 17272 ROBBINS ROAD GRAND HAVEN, MI 49417 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | — |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 30150 TELEGRAPH RD STE 408 BINGHAM FARMS, MI 48025 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $356 | — | $356 | — |
| WESTERN WAVE LLC3 | 2039 RAMBLING OAK DR MUSKEGON, MI 49445 | AFLAC | $606 | — | $606 | — |
| WESTERN WAVE LLC3 | 2039 RAMBLING OAK MUSKEGON, MI 49445 | AFLAC | $183 | $24 | $207 | — |
| LEANN P DAVIDSON3 | 871 E MCKINLEY RD ROTHBURY, MI 49452 | AFLAC | $119 | — | $119 | — |
| STEVEN MILLER3 | 89 MONROE CENTER ST NW STE 200 GRAND RAPIDS, MI 49503 | AFLAC | $89 | — | $89 | — |
| ERIC J CONDRON | 11358 WILD POND DR SE ROCKFORD, MI 49341 | AFLAC | $86 | — | $86 | — |
| JEREMY KOOI3 | 3495 HUNTER HOLLOW RD DODGEVILLE, WI 55533 | AFLAC | $81 | — | $81 | — |
| BRUCE A VAN RYN3 Filed as: BRUCE A VANRYN | 3053 RIVERDALE DR SW GRANDVILLE, MI 49418 | AFLAC | $54 | $5 | $59 | — |
| CORE DESIGN LLC3 Filed as: CORE DEISGN LLC | 10880 SANDY OAK TRAIL CEDAR SPRINGS, MI 49319 | AFLAC | $30 | — | $30 | — |
| KEVIN L ERB3 Filed as: KEVIN LERB | 5080 DOWLING ST MONTAGUE, MI 49437 | AFLAC | $29 | — | $29 | — |
| ANDREW K GLAUB3 | 2150 ASSOCIATION DRIVE SUITE 150 OKEMOS, MI 48864 | AFLAC | $27 | — | $27 | — |
| ERIC J CONDRON3 | 10880 SANDY OAK TRAIL CEDAR SPRINGS, MI 49319 | AFLAC | $20 | $5 | $25 | — |
| CAROL A SMYTHE3 | 915 LAKE AVENUE NORTH MUSKEGON, MI 49445 | AFLAC | $24 | — | $24 | — |
| BRUCE P VAN ANTWERP3 | 2578 BYRON RD HUDSONVILLE, MI 49426 | AFLAC | $24 | — | $24 | — |
| JASON SCZEPANIAK3 | 1161 HERITAGE CT SUN PRARIE, WI 49319 | AFLAC | $18 | — | $18 | — |
| JEFFREY W XAVER3 | 3982 ARLINGTON DR WILLIAMSBURG, MI 49690 | AFLAC | $16 | — | $16 | — |
| RANDALL D LADNER3 Filed as: RANDALL KIMBLER | PO BOX 302 HESPERIA, MI 49421 | AFLAC | $12 | — | $12 | — |
| SPAZ AND GLAUB ENTERPRISES3 | 2150 ASSOCIATION DR STE 150 OKEMOS, MI 48864 | AFLAC | $10 | — | $10 | — |
| NORTH STAR BENEFITS, LLC Filed as: NORTH STAR AGENCY LLC | 3277 NORTH STAR ST MUSKEGON, MI 49444 | AFLAC | $10 | — | $10 | — |
| AG AND ASSOCIATES3 | 2150 ASSOCIATION DR STE 150 OKEMOS, MI 48864 | AFLAC | $9 | — | $9 | — |
| JAMES C SNIDER JR3 | 2461 W STATE ROAD 426 STE2061 OVIEDO, FL 32765 | AFLAC | $8 | — | $8 | — |
| AG AND ASSOCIATES | 2150 ASSOCIATION DR STE 150 OKEMOS, MI 48864 | AFLAC | $7 | — | $7 | — |
| ANDREW R GRETHEL3 | 600 S HIDDEN VALLEY RD 150 CARLSBAD, CA 92011 | AFLAC | $5 | — | $5 | — |
| HEIDI E GLAUB3 Filed as: HEIDI GLAUB | 1325 OAK HOLLOW DR MILFORD, MI 48380 | AFLAC | $1 | — | $1 | — |
| STEPHANIE L KESSELRING3 Filed as: STEPHANIE KESSELRING | 3141 ROLLING GREEN CT MILFORD, MI 48380 | AFLAC | $1 | — | $1 | — |
| BRIAN FALKOWSKI3 | 17272 ROBBINDS RD S-B GRAND HAVEN, MI 49417 | BLUE CROSS BLUE SHIELD | $6K | $456 | $6K | — |
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 | 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) | PRIORITY HEALTH | 365 | $0 |
| Dental | BLUE CROSS BLUE SHIELD | 167 | $0 |
| Vision | BLUE CROSS BLUE SHIELD | 167 | $0 |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 216 | $0 |
| Short-term disability | AFLAC | 18 | $0 |
| Long-term disability(2 contracts, 2 carriers) | RELIANCE STANDARD INSURANCE COMPANY | 212 | $0 |
| Prescription drug | PRIORITY HEALTH | 365 | $0 |
| Other(3 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 216 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 365 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.