| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MELODIE CLAUSEN3 | 3055 44TH ST SW GRANDVILLE, MI 49468 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $38K | — | $38K | 3.22% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS-HENDRICKS-STUIT INS | PO BOX 953 GRANDVILLE, MI 49468 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $2K | $2K | 0.17% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS AG | PO BOX 953 GRANDVILLE, MI 49468 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $777 | $4K | 16.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS | PO BOX 953 GRANDVILLE, MI 49468 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $556 | $4K | 19.28% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS AGENCY | P.O. BOX 953 GRANDVILLE, MI 49468 | VISION SERVICE PLAN | $1K | — | $1K | 5.80% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS | P.O. BOX 953 GRANDVILLE, MI 49468 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $617 | $127 | $744 | 23.48% |
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 | 123 | 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) | 123 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 319 | $1.2M |
| Vision | VISION SERVICE PLAN | 106 | $18K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 198 | $22K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 116 | $26K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 116 | $26K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 319 | $1.2M |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 198 | $22K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 319 | — |
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.