| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COLE BARNETT3 | 140 MONROE CENTER STREET NW SUITE 200 GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $35K | $0 | $35K | 4.00% |
| MICHELLE R. STOUFFER3 Filed as: MICHELLE R STOUFFER | 140 MONROE CENTER STREET NW SUITE 200 GRAND RAPIDS, MI 49503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $4K | $0 | $4K | 8.01% |
| TRICOAST ADVISORS LLC3 | 50 LOUIS STREET NW, SUITE 510 GRAND RAPIDS, MI 49503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $311 | $311 | 0.60% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | 16805 WEST CLEVELAND AVENUE NEW BERLIN, WI 53151 | UNITED OF OMAHA LILFE INSURANCE COMPANY | $5K | $778 | $5K | 14.41% |
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 | 108 | 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) | 108 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PRIORITY HEALTH | 182 | $874K |
| Dental | BLUE CROSS BLUE SHIELD OF MICHIGAN | 147 | $52K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 147 | $52K |
| Life insurance | UNITED OF OMAHA LILFE INSURANCE COMPANY | 111 | $38K |
| Short-term disability | UNITED OF OMAHA LILFE INSURANCE COMPANY | 111 | $38K |
| Long-term disability | UNITED OF OMAHA LILFE INSURANCE COMPANY | 111 | $38K |
| Prescription drug | PRIORITY HEALTH | 182 | $874K |
| Other | UNITED OF OMAHA LILFE INSURANCE COMPANY | 111 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 182 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.