| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MICHAEL S HILL3 Filed as: MICHAEL STEVEN HILL | 6433 HIDDEN HOLLOW LN HOLLAND, MI 49423 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $9K | — | $9K | 2.27% |
| JAMES W WATSON3 Filed as: JAMES WATSON | 2000 OAK INDUSTRIAL DRIVE STE B GRAND RAPIDS, MI 49505 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $5K | — | $5K | 1.23% |
| COLDBROOK INSURANCE GROUP3 | 2000 OAK INDUSTRIAL DR STE B GRAND RAPIDS, MI 49505 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $0 | $3K | 3.36% |
| TCHP, LLC3 Filed as: TCHP LLC | 148 S RIVER AVE STE 300 HOLLAND, MI 49423 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $0 | $2K | 1.93% |
| COLDBROOK INSURANCE GROUP3 | 2000 OAK INDUSTRIAL DRIVE STE B GRAND RAPIDS, MI 49505 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $0 | $2K | 3.62% |
| TCHP, LLC3 Filed as: TCHP LLC | 148 S RIVER AVE STE 300 HOLLAND, MI 49423 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $0 | $1K | 2.06% |
| TOTAL BENEFIT SOLUTIONS3 Filed as: TOTAL CONTROL HEALTH PLANS | 148 S RIVER AVE STE 300 HOLLAND, MI 49423 | VISION SERVICE PLAN | $2K | — | $2K | 5.00% |
| COLDBROOK INSURANCE GROUP3 | 2000 OAK INDUSTRIAL DRIVE STE B GRAND RAPIDS, MI 49505 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $364 | $0 | $364 | 6.44% |
| TCHP, LLC3 Filed as: TCHP LLC | 148 S RIVER AVE STE 300 HOLLAND, MI 49423 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $280 | $0 | $280 | 4.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Claims processing; Direct payment from the plan; Float revenue; Insurance services; Consulting (general) Service code 12 | PO BOX 2888 DETROIT, MI 48231 | $278K |
| DELTA DENTAL OF MICHIGAN EIN 38-1791480 BENEFIT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | 4100 OKEMOS RD OKEMOS, MI 48864 | $13K |
| COLDBROOK INSURANCE GROUP, LLC AGENT/AGENCY | Insurance agents and brokers Service code 22 | 2000 OAK INDUSTRIAL DR. NE STE B GRAND RAPIDS, MI 49505 | $0 |
| TCHP, LLC AGENT/AGENCY | Insurance agents and brokers Service code 22 | 148 S RIVER AVE STE 300 HOLLAND, MI 49423 | $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 | 385 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 386 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 335 | $382K |
| Vision | VISION SERVICE PLAN | 300 | $35K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 385 | $82K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 385 | $67K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 385 | $88K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 385 | — |
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.