| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANDREW L. DISSELKOEN3 Filed as: ANDREW L DISSELKOEN | 1591 GALBRAITH AVENUE SE CASCADE, MI 49546 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $60K | $0 | $60K | 2.85% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 1591 GALBRAITH AVENUE SE GRAND RAPIDS, MI 49546 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $1K | $0 | $1K | 0.07% |
| ANDREW L. DISSELKOEN3 Filed as: ANDREW L DISSELKOEN | 1591 GALBRAITH AVENUE SE CASCADE, MI 49546 | PRIORITY HEALTH | $68K | $0 | $68K | 4.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 1591 GALBRAITH AVENUE SE GRAND RAPIDS, MI 49546 | DELTA DENTAL OF MICHIGAN | $6K | $0 | $6K | 3.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BOULEVARD CHICAGO, IL 60604 | DELTA DENTAL OF MICHIGAN | $2K | $0 | $2K | 0.80% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 203 NORTH LA SALLE STREET, FLOOR 20 CHICAGO, IL 60601 | DELTA DENTAL OF MICHIGAN | $2K | $0 | $2K | 0.80% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 1591 GALBRAITH AVENUE SE GRAND RAPIDS, MI 49546 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $11K | $0 | $11K | 7.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | PO BOX 2167 GRAND RAPIDS, MI 49501 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | $0 | $6K | 4.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BOULEVARD 14TH FLOOR, SUITE 14A CHICAGO, IL 60604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $3K | $3K | 1.75% |
| RICHARD JOHN DERF3 | PO BOX 143 GRAND HAVEN, MI 49417 | AFLAC | $213 | $0 | $213 | 4.61% |
| JOSEPH HOFFMAN3 Filed as: JOSEPH HOFFMAN AND OTHER AGENTS | 29110 TEMBUSO LAKE ELSINORE, CA 92530 | AFLAC | $117 | $0 | $117 | 2.53% |
| ERIC J CONDRON3 | 10880 SANDY OAK TRL CEDAR SPRINGS, MI 49319 | AFLAC | $73 | $0 | $73 | 1.58% |
| KIMBERLY S RAHRIG3 | 7 NORTH PETERSON ROAD MUSKEGON, MI 49445 | AFLAC | $60 | $0 | $60 | 1.30% |
| JEFFRY D DEKAM3 | PO BOX 407 GANDVILLE, MI 49468 | AFLAC | $49 | $0 | $49 | 1.06% |
| JAMES BULLOCK3 | 6144 WEST LONGVIEW DRIVE EAST LANSING, MI 48823 | AFLAC | $23 | $0 | $23 | 0.50% |
| JEFFREY C WERNER3 Filed as: JEFFREY WERNER LLC | 4430 GLENCOE DRIVE WILLIAMSTON, MI 48895 | AFLAC | $23 | $0 | $23 | 0.50% |
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 | 215 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 221 | 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 | 448 | $3.6M |
| Dental | DELTA DENTAL OF MICHIGAN | 597 | $191K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 448 | $2.1M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 215 | $144K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 215 | $144K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 448 | $3.6M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 215 | $149K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 597 | — |
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.