| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROY FARRELL3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $80K | — | $80K | 4.61% |
| GROTENHUIS3 | PO BOX 140167 GRAND RAPIDS, MI 49514 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $19K | — | $19K | 1.09% |
| ROY FARRELL3 | 489 SEMINOLE ROAD MUSKEGON, MI 49444 | BLUE CARE NETWORK OF MICHIGAN | $28K | — | $28K | 3.24% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | HOMETOWN HEALTH NETWORK | $26K | — | $26K | 4.84% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE ROAD MUSKEGON, MI 49444 | DELTA DENTAL PLAN OF MICHIGAN | $9K | — | $9K | 3.08% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $13K | — | $13K | 5.17% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | BLUE CROSS BLUE SHIELD OF MI | $4K | — | $4K | 4.47% |
| ROY FARRELL3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | BLUE CARE NETWORK OF MICHIGAN | $49K | — | $49K | 59.88% |
| ROY FARRELL3 | 775 BELTON AVE MUSKEGON, MI 49441 | COMMUNITY CARE HMO | $2K | — | $2K | 3.56% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | NATIONAL VISION ADMINISTRATORS, LLC. | $3K | — | $3K | 10.00% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | NATIONAL VISION ADMINISTRATORS, LLC | $941 | — | $941 | 9.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $198K |
| DELTA DENTAL OF MICHIGAN EIN 38-1791480 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $22K |
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 | 994 | 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) | 994 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(13 contracts, 5 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 316 | $4.7M |
| Dental | DELTA DENTAL PLAN OF MICHIGAN | 930 | $297K |
| Vision(2 contracts) | NATIONAL VISION ADMINISTRATORS, LLC. | 437 | $39K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 544 | $245K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 544 | $245K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 544 | $245K |
| Prescription drug(13 contracts, 5 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 316 | $4.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 930 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.