| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EDIFY NORTH, LLC3 Filed as: EDIFY NORTH LLC | 25 W 8TH ST. STE. 300 HOLLAND, MI 49423 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 14.55% |
| EDIFY NORTH, LLC3 Filed as: EDIFY NORTH LLC | 25 W 8TH ST, STE 300 HOLLAND, MI 49423 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $314 | — | $314 | 1.71% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA INC. | FT. LAUDERDALE PO BOX 203334 DALLAS, TX 75320 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $304 | — | $304 | 1.65% |
| EDIFY NORTH, LLC3 Filed as: EDIFY NORTH | 25 W 8TH ST STE 300 HOLLAND, MI 494233173 | VISION SERVICE PLAN | $660 | — | $660 | 8.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INS CO EIN 59-1031071 NONE | Participant communication; Direct payment from the plan; Non-monetary compensation; Claims processing; Contract Administrator; Other services; Float revenue; Named fiduciary Service code 12 | — | $101K |
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 | 150 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 150 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 84 | $8K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 151 | $28K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 151 | $28K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 151 | $46K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 151 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.