| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JUSTIN M HANCE3 | 8191 MOOREBRIDGE ROAD PORTAGE, MI 49024 | BLUE CROSS BLUE SHEILD | $31K | $739 | $32K | 4.85% |
| GROTENHUIS3 | P.O. BOX 140167 GRAND RAPIDS, MI 49514 | BLUE CROSS BLUE SHEILD | $7K | — | $7K | 1.05% |
| SACKETT INSURANCE GROUP3 Filed as: SACKETT INSURANCE GROUP INC. | 8191 MOORSBRIDGE ROAD PORTAGE, MI 49024 | BLUE CARE NETWORK OF MICHIGAN | $8K | — | $8K | 1.63% |
| SACKETT INSURANCE GROUP3 Filed as: SACKETT INSURANCE GROUP INC. | 8191 MOORSBRIDGE ROAD PORTAGE, MI 490247416 | AMERITAS | $3K | — | $3K | 3.24% |
| SACKETT INSURANCE GROUP3 | 8191 MOORSBRIDGE ROAD PORTAGE, MI 49024 | EYE MED | $1K | — | $1K | 9.77% |
| SACKETT INSURANCE GROUP3 Filed as: SACKETT INSURANCE GROUP, INC. | 8191 MOORSBRIDGE RD PORTAGE, MI 490247416 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $740 | — | $740 | 10.01% |
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 | 355 | 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) | 355 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHEILD | 117 | $1.1M |
| Dental | AMERITAS | 506 | $102K |
| Vision | EYE MED | 494 | $14K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 265 | $7K |
| Prescription drug | BLUE CARE NETWORK OF MICHIGAN | 86 | $484K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 265 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 506 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.