| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ADVANTAGE BENEFITS GROUP3 Filed as: ADVANTAGE BENEFITS GROUP, INC. | 89 MONROE CENTER NW STE 200 GRAND RAPIDS, MI 49503 | DELTA DENTAL OF MICHIGAN | $14K | — | $14K | 1.99% |
| ADVANTAGE BENEFITS GROUP3 Filed as: ADVANTAGE BENEFITS GROUP, INC. | 89 MONROE CTR NW STE 200 GRAND RAPIDS, MI 49503 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $20K | $732 | $20K | 6.82% |
| ADVANTAGE BENEFITS GROUP3 Filed as: ADVANTAGE BENEFITS GROUP, INC. | 89 MONROE CENTER NW STE 200 GRAND RAPIDS, MI 49503 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $9K | — | $9K | 9.98% |
| WILLIAM P KOCHIS3 Filed as: WILLIAM P. KOCHIS | 4614 ARBOR GROVE DRIVE TRAVERSE CITY, MI 49685 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | — | $1K | 3.37% |
| JOHN W POMEROY3 Filed as: JOHN W. POMEROY | 8625 REDBARK PASS TRAVERSE CITY, MI 49684 | CONTINENTAL AMERICAN INSURANCE COMPANY | $947 | — | $947 | 2.22% |
| BENJAMIN HUNTER3 | 735 S. GARFIELD AVENUE SUITE 203 TRAVERSE CITY, MI 49686 | CONTINENTAL AMERICAN INSURANCE COMPANY | $429 | — | $429 | 1.00% |
| DARIAN NULL3 Filed as: DARIAN W. NULL | 248 GROOM AVENUE COVINGTON, TN 38019 | CONTINENTAL AMERICAN INSURANCE COMPANY | $239 | — | $239 | 0.56% |
| DOUGLAS E FOX3 Filed as: DOUGLAS E. FOX | 735 S. GARFIELD AVENUE SUITE 203 TRAVERSE CITY, MI 49686 | CONTINENTAL AMERICAN INSURANCE COMPANY | $227 | — | $227 | 0.53% |
| JOHN F MOORE3 Filed as: JOHN F. MOORE | P.O. BOX 507 HIXSON, TN 37343 | CONTINENTAL AMERICAN INSURANCE COMPANY | $171 | — | $171 | 0.40% |
| HAYS COMPANIES, INC.3 Filed as: SCOTT K. HAYS | 1140 JAMES BOULEVARD SIGNAL MOUNTAIN, TN 37377 | CONTINENTAL AMERICAN INSURANCE COMPANY | $145 | — | $145 | 0.34% |
| ELIZABETH E REEVES3 Filed as: ELIZABETH E. REEVES | 1200 MOUNTAIN CREEK ROAD #102 CHATTANOOGA, TN 37405 | CONTINENTAL AMERICAN INSURANCE COMPANY | $66 | — | $66 | 0.15% |
| BRADLEY J LOWRAN3 Filed as: BRADLEY J. LOWRAN | 9553 WALKABOUT LANE TRAVERSE CITY, MI 49684 | CONTINENTAL AMERICAN INSURANCE COMPANY | $60 | — | $60 | 0.14% |
| GREGORY CRAWFORD3 Filed as: GREGORY E. CRAWFORD | 1111 S. WESTWOOD DRIVE MIDLAND, MI 48640 | CONTINENTAL AMERICAN INSURANCE COMPANY | $60 | — | $60 | 0.14% |
| BRENT L GOODE3 Filed as: BRENT L. GOODE | 2000 GLEN ECHO ROAD SUITE 204 NASHVILLE, TN 37215 | CONTINENTAL AMERICAN INSURANCE COMPANY | $43 | — | $43 | 0.10% |
| F DALE CAMERON3 Filed as: F. DALE CAMERON | 7617 WILDERNESS PATH ROAD CORRYTON, TN 37721 | CONTINENTAL AMERICAN INSURANCE COMPANY | $24 | — | $24 | 0.06% |
| JAMES SMITH3 Filed as: JAMES B. SMITH | 242 HERITAGE PARK DRIVE SUITE 106 MURFREESBORO, TN 37129 | CONTINENTAL AMERICAN INSURANCE COMPANY | $16 | — | $16 | 0.04% |
| JAY S OLEARY3 Filed as: JAY S. O'LEARY | 301 MALLORY STATION ROAD SUITE 100 FRANKLIN, TN 37067 | CONTINENTAL AMERICAN INSURANCE COMPANY | $13 | — | $13 | 0.03% |
| JOSEPH L LEDOUX3 Filed as: JOSEPH L. LEDOUX | 674 WATSON BRANCH DRIVE FRANKLIN, TN 37064 | CONTINENTAL AMERICAN INSURANCE COMPANY | $13 | — | $13 | 0.03% |
| AUSTIN T RADER3 Filed as: AUSTIN T. RADER | 242 HERITAGE PARK DRIVE SUITE 106 MURFREESBORO, TN 37129 | CONTINENTAL AMERICAN INSURANCE COMPANY | $12 | — | $12 | 0.03% |
| CHARLES HARTHUN3 | 1577 LAWSON ROAD CROSSVILLE, TN 38571 | CONTINENTAL AMERICAN INSURANCE COMPANY | $10 | — | $10 | 0.02% |
| JACKSON D RHODES3 Filed as: JACKSON D. RHODES | TWO RED BUSH COURT #3 JOHNSON CITY, TN 37601 | CONTINENTAL AMERICAN INSURANCE COMPANY | $5 | — | $5 | 0.01% |
| DEBORAH J. STOTLER3 Filed as: DEBORAH STOTLER | 317 W. MONROE RD HART, MI 49420 | COMBINED INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 14.27% |
| RICHARD KOBASIC3 | 4609 MASSILLON RD NORTH CANTON, OH 44720 | COMBINED INSURANCE COMPANY OF AMERICA | $862 | — | $862 | 3.14% |
| DANIEL KING3 | 416 OAK RD OIL CITY, PA 16301 | COMBINED INSURANCE COMPANY OF AMERICA | $13 | — | $13 | 0.05% |
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 | 901 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 35 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 936 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMBINED INSURANCE COMPANY OF AMERICA | 109 | $27K |
| Dental | DELTA DENTAL OF MICHIGAN | 2,211 | $718K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 1,416 | $91K |
| Life insurance(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,044 | $328K |
| Short-term disability(2 contracts, 2 carriers) | CONTINENTAL AMERICAN INSURANCE COMPANY | 109 | $70K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,044 | $300K |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,044 | $300K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,211 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.