| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHN W POMEROY3 Filed as: JOHN J. SCHRIPSEMA | 400 W. FRONT STREET, SUITE 206 TRAVERSE CITY, MI 496842802 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $2K | $17K | $19K | 2.59% |
| JASON NICKEL3 Filed as: JASON D. NICKEL | 4808 BROADMOOR, SE GRAND RAPIDS, MI 495125306 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $9K | — | $9K | 1.18% |
| LIGHTHOUSE GROUP3 Filed as: LIGHTHOUSE INSURANCE GROUP, INC. | 4808 BROADMOOR, SE GRAND RAPIDS, MI 49512 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $7K | — | $7K | 10.13% |
| LIGHTHOUSE GROUP3 Filed as: LIGHTHOUSE INSURANCE GROUP, INC. | 1115 TAYLOR AVENUE, N GRAND RAPIDS, MI 49503 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $4K | $4K | 5.18% |
| LIGHTHOUSE GROUP3 Filed as: LIGHTHOUSE INSURANCE GROUP, INC. | 4808 BROADMOOR, SE GRAND RAPIDS, MI 495125306 | VISION SERVICE PLAN | $958 | — | $958 | 6.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Contract Administrator; Claims processing; Other fees; Direct payment from the plan; Float revenue; Insurance services; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $12K |
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 | 220 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 220 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 183 | $725K |
| Dental | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 220 | $68K |
| Vision | VISION SERVICE PLAN | 150 | $16K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 220 | $68K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 220 | $68K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 220 | $68K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 220 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.