| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES MCKINLEY3 | 140 MONROE CENTER ST SW STE 200 GRAND RAPIDS, MI 49503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $9K | — | $9K | 2.05% |
| ACRISURE LLC3 | JAMES MCKINLEY 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | DELTA DENTAL OF MICHIGAN | $1K | — | $1K | 1.36% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA HNI RISK SER | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 12.66% |
| JOY A RYBICKI3 | 71 129TH AVE WAYLAND, MI 49348 | AFLAC | $5K | $203 | $5K | 11.40% |
| WILLIAM JOHNSON & ASSOC LLC3 | 2922 FULLER AVE NE #202 GRAND RAPIDS, MI 49505 | AFLAC | $865 | $40 | $905 | 2.10% |
| SARAH E MEANY3 | 4000 PORTAGE ST STE 109 KALAMAZOO, MI 49001 | AFLAC | $344 | $20 | $364 | 0.85% |
| EDWARD O WALTER III3 | PO BOX 1377 NOVI, MI 48376 | AFLAC | $294 | — | $294 | 0.68% |
| MARY EVELYN LEGGETT3 | 522 MAPLE ST ALLEGAN, MI 49010 | AFLAC | $82 | $11 | $93 | 0.22% |
| MERRI C SMITH3 | 492 142ND AVE CALEDONIA, MI 49316 | AFLAC | $86 | — | $86 | 0.20% |
| RAY W HINKLE3 | 6062 ARCHER ST NE ROCKFORD, MI 49341 | AFLAC | $67 | — | $67 | 0.16% |
| NICOLE DOLPHIN3 | 5314 QUEST DR SW WYOMING, MI 49418 | AFLAC | $40 | $20 | $60 | 0.14% |
| DANIEL JAY BOONE3 | 1146 GLENWOOD ST JENISON, MI 49428 | AFLAC | $48 | — | $48 | 0.11% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS AGENCY | 3055 44TH ST SW GRANDVILLE, MI 49418 | AFLAC | $35 | — | $35 | 0.08% |
| TAMARA J YOUNGS3 | 6737 BLUE HUMMINGBIRD WAY NE BELDING, MI 48809 | AFLAC | $35 | — | $35 | 0.08% |
| RONALD A DASHKOVITZ3 Filed as: RONALD ALLEN DASHKOVITZ | 139 W LAKE LANSING RD STE 200 EAST LANSING, MI 48823 | AFLAC | $29 | — | $29 | 0.07% |
| WILLIAM JOHNSON3 | 2922 FULLER AVE NE #202 GRAND RAPIDS, MI 49505 | AFLAC | $26 | $3 | $29 | 0.07% |
| MARY E WILLS3 | 9257 CLEVELAND ST APT 102 MERRILLVILLE, IN 46410 | AFLAC | $27 | — | $27 | 0.06% |
| JEFFREY C WERNER3 Filed as: JEFFREY WERNER LLC | 4430 GLENCOE DR WILLIAMSTON, MI 48895 | AFLAC | $22 | — | $22 | 0.05% |
| CHARLES V GLAUB3 | 4404 SAINT ANDREWS ST HOWELL, MI 48843 | AFLAC | $21 | — | $21 | 0.05% |
| JEANETTE V HARRIS3 | 18591 AZTEC DR SPRING LAKE, MI 49456 | AFLAC | $17 | — | $17 | 0.04% |
| ANNA LORELEI WIERENGA3 | 12860 VALLEY DR WAYLAND, MI 49348 | AFLAC | $15 | — | $15 | 0.03% |
| THOMAS S WICKEY3 | 12990 IRONWOOD RD ARGOS, IN 46501 | AFLAC | $14 | — | $14 | 0.03% |
| ELWYN D JOSLIN3 | PO BOX 197 CEDAR SPRINGS, MI 49319 | AFLAC | $9 | — | $9 | 0.02% |
| RANDALL L KIMBLER3 | PO BOX 302 HESPERIA, MI 49421 | AFLAC | $7 | — | $7 | 0.02% |
| STEPHANIE L KESSELRING3 | 5434 OAKHURST DR SEMINOLE, FL 33772 | AFLAC | $5 | — | $5 | 0.01% |
| AG AND ASSOCIATES3 | PO BOX 339 BELLAIRE, MI 49615 | AFLAC | $5 | — | $5 | 0.01% |
| JON MARTIN KETCHAM3 | 1947 142ND AVE DORR, MI 49323 | AFLAC | $5 | — | $5 | 0.01% |
| DOUGLAS E FOX3 | 6836 THAYER LAKE DR ALDEN, MI 49612 | AFLAC | $3 | — | $3 | 0.01% |
| HEATHER A DOLLIVER3 | 2150 ASSOCIATION DR OKEMOS, MI 48864 | AFLAC | $3 | — | $3 | 0.01% |
| JEFFREY C WERNER3 | 4430 GLENCOE DR WILLIAMSTON, MI 48895 | AFLAC | $3 | — | $3 | 0.01% |
| JASON SCZEPANIAK3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | AFLAC | $2 | — | $2 | 0.00% |
| HEIDI E GLAUB3 | 4404 SAINT ANDREWS ST HOWELL, MI 48843 | AFLAC | $2 | — | $2 | 0.00% |
| JAMES C SNIDER JR3 | 20817 POINTE REGATTA DR CORNELIUS, NC 28031 | AFLAC | $2 | — | $2 | 0.00% |
| THOMAS W RINGWALD3 | 37231 N 110TH ST SCOTTSDALE, AZ 85262 | AFLAC | $2 | — | $2 | 0.00% |
| JAMES BULLOCK3 | 6144 W LONGVIEW DR EAST LANSING, MI 48823 | AFLAC | $2 | — | $2 | 0.00% |
| ANDREW K GLAUB3 | PO BOX 339 BELLAIRE, MI 49615 | AFLAC | $1 | — | $1 | 0.00% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA HNI RISK SERVICES | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | EYEMED VISION CARE | $1K | — | $1K | 9.75% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA HNI RISK SER | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| JAMES MCKINLEY3 | 140 MONROE CENTER ST NW STE 200 GRAND RAPIDS, MI 49503 | BLUE CARE NETWORK OF MICHIGAN | — | — | $0 | — |
| RAY A RINGERWOLE4 | 6071 LYTHAM CT HUDSONVILLE, MI 49426 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | — | — | $0 | — |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES OF MI | 140 MONROE CENTER ST NW STE 200 GRAND RAPIDS, MI 49503 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | — | — | $0 | — |
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 | 284 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 284 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 66 | $431K |
| Dental | DELTA DENTAL OF MICHIGAN | 291 | $89K |
| Vision | EYEMED VISION CARE | 278 | $14K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 230 | $63K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 66 | $431K |
| Other(4 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 230 | $106K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 291 | — |
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.