| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALEMDA M ENGEBRETSON3 | 16805 W CLEVELAND AVE NEW BERLIN, WI 51351 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $23K | — | $23K | 3.60% |
| ALMEDA M ENGEBRETSON3 | 16805 W CLEVELAND AVE NEW BERLIN, WI 51351 | BLUE CARE NETWORK OF MICHIGAN | $19K | — | $19K | 3.82% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | 16805 W. CLEVELAND AVE NEW BERLIN, WI 53151 | COMPANION LIFE INSURANCE COMPANY | $3K | — | $3K | 3.34% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | COMPANION LIFE INSURANCE COMPANY | $2K | — | $2K | 2.06% |
| AGENT ALLIANCE CORPORATION3 | 500 CASCADE WEST PARKWAY SUITE 160 GRAND RAPIDS, MI 49546 | COMPANION LIFE INSURANCE COMPANY | $257 | — | $257 | 0.27% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | PO BOX 510187 NEW BERLIN, WI 53151 | UNITEDHEALTHCARE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| OTTAWA KENT INSURANCE AGENCY3 Filed as: OTTAWA KENT INSURANCE AGCY INC | PO BOX 349 JENISON, MI 49429 | PRINCIPAL LIFE INSURANCE COMPANY | $624 | — | $624 | 4.60% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | PRINCIPAL LIFE INSURANCE COMPANY | $491 | — | $491 | 3.62% |
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 | 240 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 240 | 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 | 117 | $1.1M |
| Dental | COMPANION LIFE INSURANCE COMPANY | 233 | $95K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 213 | $16K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 240 | $14K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 117 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 240 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.