| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GREG FARR3 | 55 CAMPAU AVE NW SUITE 400 GRAND RAPIDS, MI 49503 | NORTHWESTERN MUTUAL | $0 | $40 | $40 | — |
| TIMOTHY DILLON3 | SUITE 200 12 WASHINGTON AVE GRAND RAPIDS, MI 49417 | NORTHWESTERN MUTUAL | $0 | $123 | $123 | — |
| GREG FARR3 | 55 CAMPAU AVE NW SUITE 400 GRAND RAPIDS, MI 49503 | NORTHWESTERN MUTUAL | $0 | $74 | $74 | — |
| CHUCK SAMFILIPPO3 | 55 CAMPAU AVE NW SUITE 400 GRAND RAPIDS, MI 49503 | NORTHWESTERN MUTUAL | $10 | $4 | $14 | — |
| JD GENERAL AGENCY LLC3 | 55 CAMPAU AVE NW SUITE 400 GRAND RAPIDS, MI 49503 | NORTHWESTERN MUTUAL | $3 | $0 | $3 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GREAT WEST LIFE & ANNUITY INS. CO. EIN 84-0467907 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $8K |
| AMERICAN CENTURY EIN 44-6006315 INVESTMENT PROVIDER | Investment management fees paid indirectly by plan Service code 52 | — | $0 |
| MASS MUTUAL LIFE INS CO EIN 04-1590850 CONTRACT ADMINISTRATOR | Sub-transfer agency fees; Float revenue; Investment management fees paid indirectly by plan; Other insurance wrap fees; Soft dollars commissions; Other investment fees and expenses Service code 52 | — | $0 |
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 | 250 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 73 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 326 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | NORTHWESTERN MUTUAL | 0 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 0 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.