| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRICK DALTON3 | 3055 44TH STREET SW GRANDVILLE, MI 49468 | PRIORITY HEALTH | $40K | — | $40K | 3.88% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS. AGENCY | 3055 44TH STREET SW GRANDVILLE, MI 49468 | DELTA DENTAL OF MICHIGAN | $5K | $0 | $5K | 6.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS. AGENCY | 7000 VISTA DE ORO DRIVE NE GRANDVILLE, MI 49341 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $0 | $7K | 12.21% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS. AGENCY | 3055 44TH STREET SW GRANDVILLE, MI 49418 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 6.26% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP INSURANCE SERVICES, INC. | 1250 SOUTH CAPITAL OF TEXAS HIGHWAY SUITE 600 WEST LAKE HILLS, TX 78746 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $727 | $727 | 1.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS. AGENCY | 3055 44TH STREET SW GRANDVILLE, MI 49418 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | $1K | $0 | $1K | 10.02% |
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 | 129 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 129 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PRIORITY HEALTH | 191 | $1.0M |
| Dental | DELTA DENTAL OF MICHIGAN | 189 | $77K |
| Vision | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | 156 | $12K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 129 | $56K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 129 | $56K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 129 | $56K |
| Prescription drug | PRIORITY HEALTH | 191 | $1.0M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 129 | $56K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 191 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.