| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIAM LEY3 | 2401 WEST BIG BEAVER ROAD SUITE 400 TROY, MI 48084 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $54K | $0 | $54K | 2.25% |
| SUSAN A. MASON3 Filed as: SUSAN MASON | 3055 44TH STREET SW GRANDVILLE, MI 49418 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $19K | $0 | $19K | 0.79% |
| HYLANT GROUP INC3 Filed as: HYLANT GROUP | 2401 WEST BIG BEAVER ROAD SUITE 400 TROY, MI 48084 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $3K | $0 | $3K | 0.11% |
| HYLANT GROUP INC3 | 811 MADISON AVENUE TOLEDO, OH 43604 | DELTA DENTAL OF MICHIGAN | $13K | $0 | $13K | 9.12% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS. AGENCY | 3055 44TH STREET SW GRANDVILLE, MI 49418 | DELTA DENTAL OF MICHIGAN | $1K | $0 | $1K | 0.82% |
| HYLANT GROUP INC3 | 201 DEPOT STREET, SUITE 100 ANN ARBOR, MI 48104 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $17K | $6K | $24K | 17.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS. AGENCY | 3055 44TH STREET SW GRANDVILLE, MI 49418 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 2.55% |
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 | 202 | 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) | 202 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 394 | $2.4M |
| Dental | DELTA DENTAL OF MICHIGAN | 396 | $140K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 394 | $2.4M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 202 | $138K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 202 | $138K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 202 | $138K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 394 | $2.4M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 202 | $138K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 396 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.