| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TRIENA M ATKINSON3 Filed as: TRIENA M. ATKINSON | 1591 GALBRAITH AVENUE SE GRAND RAPIDS, MI 49546 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $29K | $0 | $29K | 1.49% |
| NANCY CRANE3 | 1591 GALBRAITH AVENUE SE GRAND RAPIDS, MI 49546 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $5K | $0 | $5K | 0.26% |
| LESLIE BAKER3 Filed as: LESLIE BAKE | UNKNOWN GRAND RAPIDS, MI 49546 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $2K | $0 | $2K | 0.11% |
| THE NULTY AGENCY INC.3 Filed as: NULTY AGENCY INC. | 5579 STADIUM DRIVE KALAMAZOO, MI 49009 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $2K | $2K | 0.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 625 KENMOOR AVENUE SE, SUITE 200 GRAND RAPIDS, MI 49546 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $13K | $0 | $13K | 6.59% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BOULEVARD CHICAGO, IL 60604 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $13K | $13K | 6.13% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | PO BOX 939 BURLINGTON, NC 27216 | DELTA DENTAL OF MICHIGAN | $7K | $205 | $7K | 6.44% |
| MICHIGAN CHAMBER SERVICES, INC.3 | 600 SOUTH WALNUT STREET LANSING, MI 48933 | DELTA DENTAL OF MICHIGAN | $2K | $0 | $2K | 2.00% |
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 | 209 | 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) | 209 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 297 | $1.9M |
| Dental | DELTA DENTAL OF MICHIGAN | 316 | $106K |
| Vision(2 contracts) | VISION SERVICE PLAN | 209 | $14K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 191 | $204K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 191 | $204K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 191 | $204K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 297 | $1.9M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 191 | $204K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 316 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.