| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRICIA L CLINE3 | 444 W MICHIGAN AVE KALAMAZOO, MI 49007 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $19K | — | $19K | 3.79% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC - CASSIE GOODBAND | 500 N WATER ST STE 900 CORPUS CHRISTI, TX 78401 | DELTA DENTAL OF MICHIGAN | $2K | — | $2K | 3.65% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC - CASSIE GOODBAND | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | DELTA DENTAL OF MICHIGAN | $715 | — | $715 | 1.16% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA KEYSER INS GROUP | 444 W MICHIGAN AVE KALAMAZOO, MI 49007 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $705 | $2K | 15.43% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA KEYSER INS GROUP | 444 W MICHIGAN AVE KALAMAZOO, MI 49007 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $826 | $240 | $1K | 11.41% |
| ACRISURE LLC3 | 444 W MICHIGAN AVE KALAMAZOO, MI 49007 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $919 | $280 | $1K | 13.04% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA KEYSER INS GROUP | 444 W MICHIGAN AVE KALAMAZOO, MI 49007 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $438 | $131 | $569 | 12.99% |
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 | 124 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 125 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 211 | $492K |
| Dental | DELTA DENTAL OF MICHIGAN | 202 | $62K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 88 | $9K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 104 | $4K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 50 | $13K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 104 | $9K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 211 | $492K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 104 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 211 | — |
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.