| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHN O'CONNOR3 Filed as: JOHN F O'CONNOR | 1406 N MITCHELL ST CADILLAC, MI 49601 | BLUE CARE NETWORK | $17K | $0 | $17K | 1.25% |
| WESLEY SPENCER3 | 528 4TH ST NW GRAND RAPIDS, MI 49504 | BLUE CARE NETWORK | $13K | $0 | $13K | 1.00% |
| GROTENHUIS3 | PO BOX 140167 GRAND RAPIDS, MI 49514 | BLUE CARE NETWORK | $4K | $0 | $4K | 0.31% |
| ADV BNFT SLTN INC DBA 44 NORTH3 | 1406 N MITCHELL ST CADILLAC, MI 49601 | BLUE CARE NETWORK | $2K | $0 | $2K | 0.15% |
| BRIAN WHITE3 Filed as: BRIAN T COTE | 1406 N MITCHELL ST CADILLAC, MI 49601 | BLUE CARE NETWORK | $1K | $0 | $1K | 0.08% |
| AXIOS INSURANCE ADVISORS, LLC3 Filed as: AXIOS INSURANCE ADVISORS LLC | 528 4TH ST NW GRAND RAPIDS, MI 49504 | STARMOUNT LIFE INSURANCE COMPANY | $22K | $0 | $22K | 14.56% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AXIOS INSURANCE ADVISORS EIN 81-1320009 AGENT | Non-monetary compensation; Other fees; Insurance agents and brokers; Other commissions; Insurance brokerage commissions and fees Service code 22 | 528 4TH ST NW GRAND RAPIDS, MI 49504 | $22K |
| JOHN F O'CONNOR AGENT | Insurance brokerage commissions and fees; Non-monetary compensation; Insurance agents and brokers; Other fees; Other commissions Service code 22 | 1406 N MITCHELL ST CADILLAC, MI 49601 | $17K |
| WESLEY SPENCER AGENT | Other fees; Other commissions; Non-monetary compensation; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | 528 4TH ST NW GRAND RAPIDS, MI 49504 | $13K |
| GROTENHUIS MGA | Insurance brokerage commissions and fees; Other commissions; Non-monetary compensation; Insurance agents and brokers; Other fees Service code 22 | PO BOX 140167 GRAND RAPIDS, MI 49514 | $4K |
| ADV BNFT SLTN INC DBA 44 NORTH AGENCY | Non-monetary compensation; Insurance brokerage commissions and fees; Insurance agents and brokers; Other fees; Other commissions Service code 22 | 1406 N MITCHELL ST CADILLAC, MI 49601 | $2K |
| BRIAN T COTE AGENT | Non-monetary compensation; Other fees; Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | 1406 N MITCHELL ST CADILLAC, MI 49601 | $1K |
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 | 163 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 163 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CARE NETWORK | 351 | $1.3M |
| Dental | STARMOUNT LIFE INSURANCE COMPANY | 106 | $152K |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 106 | $152K |
| Prescription drug | BLUE CARE NETWORK | 351 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 351 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.