| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRICK D DALTON3 | 3055 44TH ST SW GRANDVILLE, MI 49418 | BLUECROSS BLUESHIELD OF TENNESSEE INC | $3K | — | $3K | 4.26% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS AGCY IN | 3055 44TH ST SW GRANDVILLE, MI 49468 | DELTA DENTAL OF MICHIGAN | $3K | $317 | $4K | 6.92% |
| HUB INTERNATIONAL MIDWEST LIMITED Filed as: BERENDS HENDRICKS STUIT INS AGCY IN | PO BOX 953 GRANDVLLE, MI 49468 | EYE MED | $815 | — | $815 | 10.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS AGCY IN | 3055 44TH ST SW GRANDVILLE, MI 49418 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $609 | $12 | $621 | 13.59% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHSCOPES BENEFITS INC EIN 71-0347266 | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Insurance services Service code 12 | 5150 DUBLIN GRANDVILLE RD SUITE 300 COLUMBUS, OH 43081 | $64K |
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 | 61 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 62 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TENNESSEE INC | 18 | $82K |
| Dental | DELTA DENTAL OF MICHIGAN | 145 | $52K |
| Vision | EYE MED | 106 | $8K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 101 | $5K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 101 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 145 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.