| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARC D. DEVISSER3 Filed as: MARC DURAND DEVISSER | 140 MONROE CTR GRAND RAPIDS, MI 495032893 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $21K | $465 | $21K | 1.67% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES OF MICHIGAN LLC | 140 MONROE CNT ST NW STE 200 GRAND RAPIDS, MI 49503 | AMERITAS LIFE INSURANCE CORP | $10K | — | $10K | 10.00% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES OF MI LLC | 140 MONROE CENTER STE 200 GRAND RAPIDS, MI 49503 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 4.95% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES OF MI LLC | 140 MONROE CENTER STE 200 GRAND RAPIDS, MI 49503 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | — | $4K | 10.28% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES OF MI LLC | 140 MONROE CENTER STE 200 GRAND RAPIDS, MI 49503 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 9.02% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES OF MICHIGAN LLC | 140 MONROE CNT ST NW STE 200 GRAND RAPIDS, MI 49503 | AMERITAS LIFE INSURANCE CORP | $3K | — | $3K | 15.00% |
No Schedule C service providers reported on this filing.
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 | 384 | 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) | 385 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 385 | $1.3M |
| Dental | AMERITAS LIFE INSURANCE CORP | 179 | $105K |
| Vision | AMERITAS LIFE INSURANCE CORP | 132 | $21K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 300 | $25K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 231 | $63K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 300 | $38K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 385 | $1.3M |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 300 | $25K |
| 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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.