| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROY FARRELL3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $66K | $2K | $67K | 4.12% |
| GROTENHUIS3 | PO BOX 140167 GRAND RAPIDS, MI 49514 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $19K | — | $19K | 1.14% |
| ROY FARRELL3 | 489 SEMINOLE ROAD MUSKEGON, MI 49444 | BLUE CARE NETWORK OF MICHIGAN | $40K | — | $40K | 3.98% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | HOMETOWN HEALTH NETWORK | $23K | — | $23K | 4.76% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | — | $12K | 5.40% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE ROAD MUSKEGON, MI 49444 | DELTA DENTAL PLAN OF MICHIGAN | $6K | — | $6K | 3.00% |
| ROY FARRELL3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | BLUE CARE NETWORK OF MICHIGAN | $39K | — | $39K | 50.44% |
| EMPLOYEE BENEFIT SERVICES3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | BLUE CROSS BLUE SHIELD OF MI | $3K | — | $3K | 4.34% |
| BENEFIT PROFILES INC3 | 4500 CASCADE RD SE STE 106 GRAND RAPIDS, MI 49546 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 4.47% |
| ROY FARRELL3 | 489 SEMINOLE RD MUSKEGON, MI 49444 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 4.24% |
| 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 | $1K | — | $1K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF MICHIGAN EIN 38-1791480 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $14K |
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 | 1,014 | 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) | 1,014 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(12 contracts, 4 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 288 | $4.6M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL PLAN OF MICHIGAN | 687 | $271K |
| Vision(2 contracts) | NATIONAL VISION ADMINISTRATORS, LLC. | 453 | $37K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 568 | $221K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 568 | $221K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 568 | $221K |
| Prescription drug(12 contracts, 4 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 288 | $4.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 687 | — |
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."
No prospect flags tripped on this filing.