| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMY MCCULLOCH3 | 4808 BROADMOOR SE GRAND RAPIDS, MI 49515 | PRIORITY HEALTH | $31K | — | $31K | 1.99% |
| LIGHTHOUSE GROUP3 Filed as: LIGHTHOUSE INS GROUP INC. | 4808 BROADMOOR AVE SE GRAND RAPIDS, MI 495125306 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $338 | $6K | 14.66% |
| LIGHTHOUSE GROUP3 Filed as: LIGHTHOUSE INS GROUP INC. | 4808 BROADMOOR AVE SE GRAND RAPIDS, MI 495125306 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $306 | $4K | 11.49% |
| LIGHTHOUSE GROUP3 Filed as: LIGHTHOUSE INS GROUP INC. | 4808 BROADMOOR AVE SE GRAND RAPIDS, MI 495125306 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $347 | $2K | 11.74% |
| LIGHTHOUSE GROUP3 Filed as: LIGHTHOUSE INS GROUP INC. | 4808 BROADMOOR AVE SE GRAND RAPIDS, MI 495125306 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $99 | $1K | 10.90% |
| LIGHTHOUSE GROUP3 Filed as: LIGHTHOUSE INS GROUP INC. | 4808 BROADMOOR AVE SE GRAND RAPIDS, MI 495125306 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $832 | — | $832 | 10.00% |
| LIGHTHOUSE GROUP3 Filed as: LIGHTHOUSE INS GROUP INC. | 4808 BROADMOOR AVE SE GRAND RAPIDS, MI 495125306 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $536 | $45 | $581 | 10.84% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNION SECURITY INSURANCE COMPANY EIN 81-0170040 TPA | Non-monetary compensation; Claims processing; Insurance agents and brokers; Other fees Service code 12 | — | $111K |
| LIGHTHOUSE INSURANCE GROUP INC BROKER | Insurance agents and brokers; Other commissions Service code 22 | 4808 BROADMOOR SE GRAND RAPIDS, MI 49512 | $2K |
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 | 223 | 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) | 223 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PRIORITY HEALTH | 357 | $1.5M |
| Vision | VISION SERVICE PLAN INSURANCE COMPANY | 129 | $18K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 223 | $5K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 8 | $8K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 223 | $36K |
| Prescription drug | PRIORITY HEALTH | 357 | $1.5M |
| Other(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 223 | $74K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 357 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.