| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HYLANT GROUP INC3 | PO BOX 1687 TOLEDO, OH 43603 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $7K | $7K | 0.53% |
| MICHAEL S HILL3 | 45 COLDBROOK ST NW GRAND RAPIDS, MI 49503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $4K | — | $4K | 0.29% |
| GUYLAINE D DONAVAN3 | 85 CAMPAU AVE NW STE 100 GRAND RAPIDS, MI 49503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $4K | — | $4K | 0.27% |
| JAMES W WATSON3 | 45 COLDBROOK ST NW GRAND RAPIDS, MI 49503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $1K | — | $1K | 0.08% |
| HYLANT GROUP INC3 | 8 CADILLAC DR STE 230 BRENTWOOD, TN 37027 | DELTA DENTAL | $7K | $1K | $9K | 1.66% |
| COLDBROOK INSURANCE GROUP3 | 45 COLDBROOK ST NW GRAND RAPIDS, MI 49503 | DELTA DENTAL | $3K | — | $3K | 0.62% |
| HYLANT GROUP INC3 | 811 MADISON AVE TOLEDO, OH 43604 | LIFE INSURANCE OF NORTH AMERICA | $4K | — | $4K | 1.70% |
| COLDBROOK INSURANCE GROUP3 | 45 COLDBROOK ST NW GRAND RAPIDS, MI 49503 | LIFE INSURANCE OF NORTH AMERICA | $473 | — | $473 | 0.19% |
| HYLANT GROUP INC3 | 811 MADISON AVE TOLEDO, OH 43604 | LIFE INSURANCE OF NORTH AMERICAN | $5K | — | $5K | 2.98% |
| COLDBROOK INSURANCE GROUP3 | 45 COLDBROOK ST NW GRAND RAPIDS, MI 49503 | LIFE INSURANCE OF NORTH AMERICAN | $538 | — | $538 | 0.32% |
| HYLANT GROUP INC3 | 811 MADISON AVE TOLEDO, OH 43604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 9.11% |
| COLDBROOK INSURANCE GROUP3 | 45 COLDBROOK ST NW GRAND RAPIDS, MI 49503 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $669 | — | $669 | 3.52% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Float revenue; Consulting (general); Claims processing; Non-monetary compensation; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Contract Administrator; Insurance services; Other fees Service code 12 | 600 LAFAYETTE EAST DETRIOT, MI 48226 | $720K |
| GUYLAINE D DONAVAN AGENT/BROKER | Other fees; Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees; Non-monetary compensation Service code 22 | 85 CAMPAU AVE NW STE 100 GRAND RAPIDS, MI 49503 | $0 |
| HYLANT GROUP INC AGENT/BROKER | Non-monetary compensation; Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers; Other fees Service code 22 | PO BOX 1687 TOLEDO, OH 43603 | $0 |
| JAMES W WATSON AGENT/BROKER | Insurance brokerage commissions and fees; Non-monetary compensation; Insurance agents and brokers; Other fees; Other commissions Service code 22 | 45 COLDBROOK ST NW GRAND RAPIDS, MI 49503 | $0 |
| MICHAEL S HILL AGENT/BROKER | Other commissions; Other fees; Non-monetary compensation; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | 45 COLDBROOK ST NW GRAND RAPIDS, MI 49503 | $0 |
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 | 1,351 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,360 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL | 2,110 | $529K |
| Vision | VISION SERVICE PLAN | 881 | $132K |
| Life insurance | LIFE INSURANCE OF NORTH AMERICA | 1,351 | $253K |
| Long-term disability | LIFE INSURANCE OF NORTH AMERICAN | 135 | $170K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 2,389 | $1.4M |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,351 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,389 | — |
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.