| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRICK D DALTON3 Filed as: PATRICK D. DALTON | PO BOX 953 GRANDVILLE, MI 49468 | BLUE CARE NETWORK OF MICHIGAN | $25K | — | $25K | 2.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS. AGENCY | 3055 44TH STREET SW GRANDVILLE, MI 49418 | BLUE CARE NETWORK OF MICHIGAN | $0 | $1K | $1K | 0.13% |
| PATRICK D DALTON3 Filed as: PATRICK D. DALTON | PO BOX 953 GRANDVILLE, MI 49468 | BLUE CROSS AND BLUE SHIELD OF MICHIGAN | $6K | $0 | $6K | 2.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS. AGENCY | 3055 44TH STREET SW GRANDVILLE, MI 49418 | BLUE CROSS AND BLUE SHIELD OF MICHIGAN | $0 | $232 | $232 | 0.10% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS. AGENCY | 3055 44TH STREET SW GRANDVILLE, MI 49418 | DELTA DENTAL OF MICHIGAN | $11K | $375 | $11K | 10.26% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS. AGENCY | 3055 44TH STREET SW GRANDVILLE, MI 49418 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $3K | $12K | 15.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS. AGENCY | PO BOX 953 GRANDVILLE, MI 49468 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | $963 | $0 | $963 | 10.00% |
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 | 176 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 176 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 209 | $1.1M |
| Dental | DELTA DENTAL OF MICHIGAN | 333 | $111K |
| Vision | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | 314 | $10K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 176 | $78K |
| Short-term disability(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF MICHIGAN | 176 | $306K |
| Long-term disability(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF MICHIGAN | 176 | $306K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 209 | $1.1M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 176 | $78K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 333 | — |
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."
No prospect flags tripped on this filing.