| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COLDBROOK INSURANCE GROUP3 | 45 COLDBROOK ST NW GRAND RAPIDS, MI 49503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $49K | — | $49K | 4.52% |
| HYLANT GROUP INC3 | 85 CAMPAU WAY STE 100 GRAND RAPIDS, MI 49503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $7K | $7K | 0.61% |
| COLDBROOK INSURANCE GROUP3 | 45 COLDBROOK ST NW GRAND RAPIDS, MI 49503 | DELTA DENTAL | $6K | $3K | $8K | 1.99% |
| COLDBROOK INSURANCE GROUP3 | 45 COLDBROOK ST NW GRAND RAPIDS, MI 49503 | LIFE INSURANCE OF NORTH AMERICA | $5K | — | $5K | 2.07% |
| HYLANT GROUP INC7 | 811 MADISON AVE TOLEDO, OH 43604 | LIFE INSURANCE OF NORTH AMERICA | — | $215 | $215 | 0.10% |
| COLDBROOK INSURANCE GROUP3 | 45 COLDBROOK ST NW GRAND RAPIDS, MI 49503 | LIFE INSURANCE OF NORTH AMERICA | $6K | — | $6K | 3.53% |
| HYLANT GROUP INC7 | 811 MADISON AVE TOLEDO, OH 43604 | LIFE INSURANCE OF NORTH AMERICA | — | $144 | $144 | 0.09% |
| COLDBOOK INSURANCE GROUP3 | 2000 OAK INDUSTRIAL DR STE B GRAND RAPIDS, MI 49505 | VISION SERVICE PLAN | $4K | — | $4K | 4.45% |
| COLDBROOK INSURANCE GROUP3 Filed as: COLDBROOK | 45 COLDBROOK ST NW GRAND RAPIDS, MI 49503 | LIFE INSURANCE OF NORTH AMERICA | $2K | — | $2K | 13.17% |
| HYLANT GROUP INC7 | 811 MADISON AVE TOLEDO, OH 43604 | LIFE INSURANCE OF NORTH AMERICA | — | $15 | $15 | 0.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Non-monetary compensation; Claims processing; Contract Administrator; Other fees; Direct payment from the plan; Insurance services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general) Service code 12 | 600 LAFAYETTE EAST DETRIOT, MI 48226 | $623K |
| HYLANT GROUP INC AGENT/BROKER | Other fees; Insurance agents and brokers; Insurance brokerage commissions and fees; Non-monetary compensation; Other commissions Service code 22 | PO BOX 1687 TOLEDO, OH 43603 | $0 |
| JAMES WATSON AGENT/BROKER | Non-monetary compensation; Other fees; Insurance agents and brokers; Other commissions; Insurance brokerage commissions and fees Service code 22 | 45 COLDBROOK ST NW GRAND RAPIDS, MI 11351 | $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 | 871 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 875 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL | 1,701 | $421K |
| Vision | VISION SERVICE PLAN | 693 | $99K |
| Life insurance | LIFE INSURANCE OF NORTH AMERICA | 871 | $223K |
| Long-term disability | LIFE INSURANCE OF NORTH AMERICA | 871 | $158K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,713 | $1.1M |
| Other | LIFE INSURANCE OF NORTH AMERICA | 871 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,713 | — |
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.