| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANJA HARMON3 | 1591 GALBRAITH AVENUE SOUTHEAST GRAND RAPIDS, MI 49546 | BLUE CARE NETWORK OF MICHIGAN | $33K | $0 | $33K | 5.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 1591 GALBRAITH AVENUE SOUTHEAST GRAND RAPIDS, MI 49546 | BLUE CARE NETWORK OF MICHIGAN | $0 | $970 | $970 | 0.15% |
| ANJA HARMON3 | 1591 GALBRAITH AVENUE SOUTHEAST GRAND RAPIDS, MI 49546 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $19K | $0 | $19K | 4.65% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 1591 GALBRAITH AVENUE SOUTHEAST GRAND RAPIDS, MI 49546 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $388 | $388 | 0.10% |
| ANJA HARMON3 | 1591 GALBRAITH AVENUE SOUTHEAST GRAND RAPIDS, MI 49546 | DELTA DENTAL OF MICHIGAN | $4K | $0 | $4K | 4.40% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF IN LTD | PO BOX 2167 GRAND RAPIDS, MI 49501 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | -$412 | $5K | 11.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | PO BOX 2167 GRAND RAPIDS, MI 49501 | VISION SERVICE PLAN | $2K | $0 | $2K | 10.00% |
| MARC JACOBSON3 Filed as: MARC J. JACOBSON | 425 HUEHL ROAD, SUITE 16B NORTHBROOK, IL 60062 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $32 | $0 | $32 | 1.14% |
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 | 116 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 116 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 120 | $1.1M |
| Dental | DELTA DENTAL OF MICHIGAN | 203 | $100K |
| Vision | VISION SERVICE PLAN | 95 | $17K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 73 | $40K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 1 | $3K |
| Prescription drug | BLUE CARE NETWORK OF MICHIGAN | 120 | $645K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 203 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.