| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DOUGLAS L DERKS3 Filed as: DOUGLAS DERKS | 2 PIERCE FL 14TH FLOOR ITASCA, IL 60143 | PRIORITY HEALTH | $35K | — | $35K | 3.00% |
| 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 | $9K | $178 | $9K | 15.35% |
| EMPLOYERS INSURANCE GROUP INC3 Filed as: EMPLOYERS INSURANCE AGENCY | 17272 ROBBINS RD. STE. B GRAND HAVEN, MI 49417 | RELIANCE STANDARD LIFE INSURANCE COMPANY | -$21 | — | -$21 | -0.04% |
| WESTERN WAVE LLC3 | 2039 RAMBLING OAK DRIVE MUSKEGON, MI 49445 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2K | — | $2K | 4.23% |
| ERIC J CONDRON3 | 10880 SANDY OAK TRAIL CEDAR SPRINGS, MI 49319 | CONTINENTAL AMERICAN INSURANCE COMPANY | $768 | — | $768 | 1.44% |
| NORTHSTAR AGENCY LLC3 Filed as: NORTHSTAR AGENCY, LLC | 5754 FARR ROAD FRUITPORT, MI 49415 | CONTINENTAL AMERICAN INSURANCE COMPANY | $645 | — | $645 | 1.21% |
| ERIC J CONDRON3 | 10880 SANDY OAK TRAIL CEDAR SPRINGS, MI 49319 | CONTINENTAL AMERICAN INSURANCE COMPANY | $523 | — | $523 | 0.98% |
| BRUCE A VAN RYN3 | 3053 RIVERVALE DRIVE SOUTHWEST GRANDVILLE, MI 49418 | CONTINENTAL AMERICAN INSURANCE COMPANY | $512 | — | $512 | 0.96% |
| JEFFREY C WERNER3 | 18096 TRUDY DR SPRING LAKE, MI 49456 | CONTINENTAL AMERICAN INSURANCE COMPANY | $261 | — | $261 | 0.49% |
| MIKE S GAYNOR3 | 8672 SHORE WAY DRIVE SW BYRON CENTER, MI 49315 | CONTINENTAL AMERICAN INSURANCE COMPANY | $240 | — | $240 | 0.45% |
| AG AND ASSOCIATES3 | 2150 ASSOCIATION DRIVE STE 150 OKEMOS, MI 48864 | CONTINENTAL AMERICAN INSURANCE COMPANY | $219 | — | $219 | 0.41% |
| K HARRIS & ASSOCIATES, LLC3 | 950 W. NORTON AVE STE 201 MUSKEGON, MI 49441 | CONTINENTAL AMERICAN INSURANCE COMPANY | $157 | — | $157 | 0.29% |
| BENEFIT INNOVATIONS LLP3 Filed as: BENEFIT INNOVATIONS LLC | 5567 MADISON AVE HUDSONVILLE, MI 49426 | CONTINENTAL AMERICAN INSURANCE COMPANY | $47 | — | $47 | 0.09% |
| HEATHER A DOLLIVER3 | 212 W SILVER LAKE ROAD FENTON, MI 48430 | CONTINENTAL AMERICAN INSURANCE COMPANY | $46 | — | $46 | 0.09% |
| CHRIS D BOULDREY3 | 340 WOOD HILLS DRIVE CONCORD, MI 49237 | CONTINENTAL AMERICAN INSURANCE COMPANY | $34 | — | $34 | 0.06% |
| JAMES C SNIDER JR3 Filed as: JAMES C SNIDER | 830 JUANITA RAEL WINTER PARK, FL 32789 | CONTINENTAL AMERICAN INSURANCE COMPANY | $34 | — | $34 | 0.06% |
| JIM M BULLOCK3 | 3715 POWDERHORN DR. OKEMOS, MI 48864 | CONTINENTAL AMERICAN INSURANCE COMPANY | $25 | — | $25 | 0.05% |
| STEPHANIE L KESSELRING3 | 3141 ROLLING GREEN CT MILFORD, MI 48380 | CONTINENTAL AMERICAN INSURANCE COMPANY | $21 | — | $21 | 0.04% |
| JEFFREY C WERNER3 | 18096 TRUDY DR SPRING LAKE, MI 49456 | CONTINENTAL AMERICAN INSURANCE COMPANY | $17 | — | $17 | 0.03% |
| AG AND ASSOCIATES3 | 2150 ASSOCIATION DRIVE STE 150 OKEMOS, MI 48864 | CONTINENTAL AMERICAN INSURANCE COMPANY | $14 | — | $14 | 0.03% |
| AG AND ASSOCIATES3 | 2150 ASSOCIATION DRIVE STE 150 OKEMOS, MI 48864 | CONTINENTAL AMERICAN INSURANCE COMPANY | $9 | — | $9 | 0.02% |
| JULIE SLAUGHTER3 | 430 BOARDWALK WALLED LAKE, MI 48390 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| 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 | $8K | $152 | $8K | 15.30% |
| EMPLOYERS INSURANCE GROUP INC3 Filed as: EMPLOYERS INSURANCE AGENCY | 17272 ROBBINS RD. STE. B GRAND HAVEN, MI 49417 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| 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 | $5K | $188 | $5K | 15.72% |
| EMPLOYERS INSURANCE GROUP INC3 Filed as: EMPLOYERS INSURANCE AGENCY | 17272 ROBBINS RD. STE B GRAND HAVEN, MI 49417 | RELIANCE STANDARD LIFE INSURANCE COMPANY | -$56 | — | -$56 | -0.17% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | 30150 TELEGRAPH RD. STE 408 BINGHAM FARMS, MI 48025 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $53 | $2K | 15.33% |
| EMPLOYERS INSURANCE GROUP INC3 Filed as: EMPLOYERS INSURANCE AGENCY | 17272 ROBBINS RD. STE B GRAND HAVEN, MI 49417 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | NATIONAL VISION ADMINISTRATORS, LLC | $1K | — | $1K | 10.00% |
| WESTERN WAVE LLC3 | 2039 RAMBLING OAK DR MUSKEGON, MI 49445 | AFLAC | $584 | — | $584 | 5.22% |
| ERIC J CONDRON3 | 11358 WILD POND DR SE ROCKFORD, MI 49341 | AFLAC | $91 | — | $91 | 0.81% |
| STEVEN MILLER3 | 89 MONROE CENTER ST NW STE 200 GRAND RAPIDS, MI 49503 | AFLAC | $87 | — | $87 | 0.78% |
| JEREMY KOOI3 Filed as: JEREMY KOOL | 3495 HUNTER HOLLOW RD DODGEVILLE, WI 53533 | AFLAC | $80 | — | $80 | 0.72% |
| WESTERN WAVE LLC3 | 2039 RAMBLING OAK DR MUSKEGON, MI 49445 | AFLAC | $80 | — | $80 | 0.72% |
| LEANN P DAVIDSON3 | 871 E MCKINLEY RD ROTHBURY, MI 49452 | AFLAC | $62 | — | $62 | 0.55% |
| BRUCE A VAN RYN3 | 3053 RIVERVALE DR SW GRANDVILLE, MI 49418 | AFLAC | $37 | — | $37 | 0.33% |
| KEVIN L ERB3 | 5080 DOWLING ST MONTAGUE, MI 49437 | AFLAC | $35 | — | $35 | 0.31% |
| CAROL A SMYTHE3 | 915 LAKE AVENUE NORTH MUSKEGON, MI 49445 | AFLAC | $26 | — | $26 | 0.23% |
| BRUCE P VAN ANTWERP3 | 2578 BYRON RD HUDSONVILLE, MI 49426 | AFLAC | $26 | — | $26 | 0.23% |
| ANDREW K GLAUB3 | 6155 GRAEBEAR TRL EAST LANSING, MI 48823 | AFLAC | $23 | — | $23 | 0.21% |
| RANDALL L KIMBLER3 | PO BOX 302 HESPERIA, MI 49421 | AFLAC | $21 | — | $21 | 0.19% |
| JASON SCZEPANIAK3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | AFLAC | $19 | — | $19 | 0.17% |
| ERIC J CONDRON3 | 10880 SANDY OAK TRL CEDAR SPRINGS, MI 49319 | AFLAC | $18 | — | $18 | 0.16% |
| NORTHSTAR AGENCY LLC3 | 5754 FARR RD FRUITPORT, MI 49415 | AFLAC | $13 | — | $13 | 0.12% |
| JEFFREY W XAVER3 | 3982 ARLINGTON DR WILLIAMSBURG, MI 49690 | AFLAC | $10 | — | $10 | 0.09% |
| SPAZ AND GLAUB ENTERPRISES3 | 2150 ASSOCIATION DRIVE STE 150 OKEMOS, MI 48864 | AFLAC | $10 | — | $10 | 0.09% |
| AG AND ASSOCIATES3 | 6155 GRAEBEAR TRL EAST LANSING, MI 48823 | AFLAC | $9 | — | $9 | 0.08% |
| JAMES C SNIDER JR3 | 2301 LUCIEN WAY STE 150 MAITLAND, FL 32751 | AFLAC | $4 | — | $4 | 0.04% |
| HEIDI E GLAUB3 | 1325 OAK HOLLOW DR MILFORD, MI 48380 | AFLAC | $3 | — | $3 | 0.03% |
| JEFFREY W XAVER3 | 5300 EAGLES NEST LN LELAND, MI 49654 | AFLAC | $3 | — | $3 | 0.03% |
| ALAN BERGMANN3 | 2144 MADERO DR THE VILLAGES, FL 32159 | AFLAC | $2 | — | $2 | 0.02% |
| STEPHANIE L KESSELRING3 | 3141 ROLLING GREEN CT MILFORD, MI 48380 | AFLAC | $2 | — | $2 | 0.02% |
| HEATHER A DOLLIVER3 | 2150 ASSOCIATION DR OKEMOS, MI 48864 | AFLAC | $1 | — | $1 | 0.01% |
| JEFFREY C WERNER3 | 18096 TRUDY DR SPRING LAKE, MI 49456 | AFLAC | $1 | — | $1 | 0.01% |
| ANNIE GLAUB3 | 6155 GRAEBEAR TRL EAST LANSING, MI 48823 | AFLAC | $1 | — | $1 | 0.01% |
| CHRISTOPHER D BOULDREY3 | PO BOX 602 CONCORD, MI 49237 | AFLAC | $1 | — | $1 | 0.01% |
| JAMES BULLOCK3 | 3715 POWDERHORN DR OKEMOS, MI 48864 | AFLAC | $1 | — | $1 | 0.01% |
| THOMAS W RINGWALD3 | 37231 N 110TH ST SCOTTSDALE, AZ 85262 | AFLAC | $1 | — | $1 | 0.01% |
| MICHELLE R CALVIN3 | PO BOX 99 JONESVILLE, MI 49250 | AFLAC | — | — | $0 | 0.00% |
| DOUGLAS L DERKS3 | 2 PIERCE PLACE FLOOR 14TH ITASCA, IL 60143 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $7K | $7K | — |
| BRIAN FALKOWSKI3 | 17272 ROBBINS RD S-B GRAND HAVEN, MI 49417 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $257 | $257 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS AND BLUE SHIELD OF MI EIN 38-2069753 TPA | Claims processing Service code 12 | — | $7K |
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 | 194 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 195 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PRIORITY HEALTH | 341 | $1.2M |
| Dental | BLUE CROSS BLUE SHIELD OF MICHIGAN | 159 | $0 |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 297 | $15K |
| Life insurance(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 214 | $50K |
| Short-term disability(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 153 | $69K |
| Long-term disability(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 198 | $62K |
| Prescription drug | PRIORITY HEALTH | 341 | $1.2M |
| Other(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 214 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 341 | — |
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.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.