| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES MCKINLEY3 | 1543 BROOKWOOD DRIVE MUSKEGON, MI 49441 | PRIORITY HEALTH | $21K | $0 | $21K | 1.67% |
| COLE BARNETT3 | 140 MONROE CENTER STREET SUITE 200 GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $5K | $0 | $5K | 0.36% |
| JAMES MCKINLEY3 | 1543 BROOKWOOD DRIVE MUSKEGON, MI 49441 | PRIORITY HEALTH INSURANCE COMPANY | $4K | $0 | $4K | 1.63% |
| COLE BARNETT3 | 140 MONROE CENTER STREET SUITE 200 GRAND RAPIDS, MI 49503 | PRIORITY HEALTH INSURANCE COMPANY | $874 | $0 | $874 | 0.37% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | DELTA DENTAL OF MICHIGAN | $3K | $0 | $3K | 4.37% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES OF MI LLC | 16805 WEST CLEVELAND AVENUE NEW BERLIN, WI 53151 | DELTA DENTAL OF MICHIGAN | $1K | $0 | $1K | 1.56% |
| ACRISURE LLC3 | 16805 WEST CLEVELAND AVENUE NEW BERLIN, WI 53151 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $343 | $6K | 11.40% |
| TRICOAST ADVISORS LLC3 Filed as: TRICOAST ADVISORS | 50 LOUIS STREET NW, SUITE 510 GRAND RAPIDS, MI 49503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $920 | $0 | $920 | 1.67% |
| TRICOAST ADVISORS LLC3 Filed as: TRICOAST ADVISORS | PO BOX 510187 NEW BERLIN, WI 53151 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $314 | $0 | $314 | 0.57% |
| JOY A RYBICKI3 Filed as: JOY RYBICKI | 71 129TH AVENUE WAYLAND, MI 49348 | AFLAC | $5K | $134 | $5K | 10.15% |
| WILLIAM JOHNSON & ASSOC LLC3 Filed as: WILLIAM JOHNSON & ASSOCIATES | 2922 FULLER AVENUE NE, SUITE 202 GRAND RAPIDS, MI 49505 | AFLAC | $1K | $37 | $1K | 2.28% |
| MARY EVELYN LEGGETT3 Filed as: MARY LEGGETT | 522 MAPLE STREET ALLEGAN, MI 49010 | AFLAC | $524 | $23 | $547 | 1.18% |
| MJ INSURANCE3 Filed as: MARY WILLS AND VARIOUS AGENTS | 9257 CLEVELAND STREET APARTMENT 102 MERRILLVILLE, IN 46410 | AFLAC | $403 | $0 | $403 | 0.87% |
| EDWARD O WALTER III3 Filed as: EDWARD WALTER | PO BOX 1377 NOVI, MI 48376 | AFLAC | $401 | $0 | $401 | 0.87% |
| RAY W HINKLE3 Filed as: RAY HINKLE | 6062 ARCHER STREET NE ROCKFORD, MI 49341 | AFLAC | $307 | $37 | $344 | 0.74% |
| MERRI C SMITH3 Filed as: MERRI SMITH | 492 142ND AVENUE CALEDONIA, MI 49316 | AFLAC | $86 | $0 | $86 | 0.19% |
| ACRISURE LLC3 | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | $998 | $0 | $998 | 8.28% |
| HNIN RISK SERVICES3 | 140 MONROE CENTER STREET SUITE 200 GRAND RAPIDS, MI 49503 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | $201 | $0 | $201 | 1.67% |
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 | 126 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 128 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PRIORITY HEALTH | 219 | $1.5M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF MICHIGAN | 241 | $115K |
| Vision(2 contracts, 2 carriers) | AFLAC | 201 | $58K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 192 | $55K |
| Short-term disability | AFLAC | 52 | $46K |
| Prescription drug(2 contracts, 2 carriers) | PRIORITY HEALTH | 219 | $1.5M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 192 | $101K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 241 | — |
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.