| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES W WATSON3 Filed as: JAMES WATSON | 2000 OAK INDUSTRIAL DR STE B GRAND RAPIDS, MI 49505 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $28K | — | $28K | 3.50% |
| COLDBROOK INSURANCE GROUP3 Filed as: COLDBROOK INSURANCE GROUP LLC | 2000 OAK INDUSTRIAL DR STE B GRAND RAPIDS, MI 49505 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $5K | $5K | 0.69% |
| COLDBROOK INSURANCE GROUP3 | 2000 OAK INDUSTRIAL DRIVE NE SUITE B GRAND RAPIDS, MI 49505 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $0 | $4K | 2.21% |
| COLDBROOK INSURANCE GROUP3 | 2000 OAK INDUSTRIAL DRIVE NE SUITE B GRAND RAPIDS, MI 49505 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $0 | $4K | 2.44% |
| MICHIGAN CHAMBER SERVICES, INC.3 Filed as: MICHIGAN CHAMBER SERVICES INC | 600 S WALNUT ST LANSING, MI 489332209 | VISION SERVICE PLAN | $6K | $0 | $6K | 7.68% |
| COLDBROOK INSURANCE GROUP3 | 2000 OAK INDUSTRIAL DRIVE NE SUITE B GRAND RAPIDS, MI 49505 | VISION SERVICE PLAN | $4K | $0 | $4K | 4.80% |
| COLDBROOK INSURANCE GROUP3 | 2000 OAK INDUSTRIAL DRIVE NE SUITE B GRAND RAPIDS, MI 49505 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $0 | $4K | 9.84% |
| COLDBROOK INSURANCE GROUP3 | 2000 OAK INDUSTRIAL DRIVE NE SUITE B GRAND RAPIDS, MI 49505 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $126 | $0 | $126 | — |
| COLDBROOK INSURANCE GROUP3 | 2000 OAK INDUSTRIAL DRIVE NE SUITE B GRAND RAPIDS, MI 49505 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$53 | $0 | -$53 | — |
| COLDBROOK INSURANCE GROUP3 | 2000 OAK INDUSTRIAL DRIVE NE SUITE B GRAND RAPIDS, MI 49505 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$73 | $0 | -$73 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Recordkeeping and information management (computing, tabulating, data processing, etc.); Insurance services; Float revenue; Claims processing; Consulting (general); Contract Administrator; Other fees; Direct payment from the plan; Non-monetary compensation Service code 12 | 600 E LAFAYETTE BLVD DETROIT, MI 48226 | $524K |
| DELTA DENTAL OF MICHIGAN EIN 38-1791480 BENEFIT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | 4100 OKEMOS RD OKEMOS, MI 48864 | $27K |
| COLDBROOK INSURANCE GROUP LLC BROKER | Insurance brokerage commissions and fees; Non-monetary compensation; Other commissions; Other fees; Insurance agents and brokers Service code 22 | 2000 OAK INDUSTRIAL DR STE B GRAND RAPIDS, MI 49505 | $0 |
| JAMES WATSON BROKER | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees; Non-monetary compensation; Other fees Service code 22 | 2000 OAK INDUSTRIAL DR STE B GRAND RAPIDS, MI 49505 | $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 | 394 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 402 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 321 | $79K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 394 | $176K |
| Long-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 394 | $158K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 754 | $788K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 394 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 754 | — |
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.