| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DOUGLAS L DERKS3 Filed as: DOUGLAS DERKS | 2 PIERCE PL 14TH FLOOR ITASCA, IL 60143 | PRIORITY HEALTH | $44K | — | $44K | 3.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 30150 TELEGRAPH RD, STE 408 BINGHAM FARMS, MI 480255708 | METROPOLITAN LIFE INSURANCE COMPANY | $19K | — | $19K | 10.90% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 600063009 | METROPOLITAN LIFE INSURANCE COMPANY | — | $2K | $2K | 1.32% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 1111 SUPERIOR AVE E STE 1601 CLEVELAND, OH 441142522 | METROPOLITAN LIFE INSURANCE COMPANY | — | $23 | $23 | 0.01% |
| NORTHSTAR AGENCY LLC3 Filed as: NORTHSTAR AGENCY, LLC | 5754 FARR ROAD FRUITPORT, MI 49415 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | — | $1K | 3.37% |
| WESTERN WAVE LLC3 | 2039 RAMBLING OAK DRIVE MUSKEGON, MI 49445 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | — | $1K | 2.54% |
| ERIC J CONDRON3 | 10880 SANDY OAK TRAIL CEDAR SPRINGS, MI 49319 | CONTINENTAL AMERICAN INSURANCE COMPANY | $570 | — | $570 | 1.38% |
| ERIC J CONDRON3 | 10880 SANDY OAK TRAIL CEDAR SPRINGS, MI 49319 | CONTINENTAL AMERICAN INSURANCE COMPANY | $304 | — | $304 | 0.74% |
| ANNETTE L RUS3 | 5135 S. HILTON PARK RD FRUITPORT, MI 49415 | CONTINENTAL AMERICAN INSURANCE COMPANY | $225 | — | $225 | 0.54% |
| SANTIAGO & ASSOCIATES LLC3 Filed as: SANTIAGO & ASSOCIATES, LLC | 950 W. NORTON AVE STE 201 MUSKEGON, MI 49441 | CONTINENTAL AMERICAN INSURANCE COMPANY | $223 | — | $223 | 0.54% |
| BRUCE A VAN RYN3 | 3053 RIVERVALE DRIVE SOUTHWEST GRANDVILLE, MI 49418 | CONTINENTAL AMERICAN INSURANCE COMPANY | $218 | — | $218 | 0.53% |
| JEFFREY C WERNER3 | 18096 TRUDY DR SPRING LAKE, MI 49456 | CONTINENTAL AMERICAN INSURANCE COMPANY | $193 | — | $193 | 0.47% |
| AG AND ASSOCIATES3 | 2150 ASSOCIATION DRIVE STE 150 OKEMOS, MI 48864 | CONTINENTAL AMERICAN INSURANCE COMPANY | $160 | — | $160 | 0.39% |
| BENEFIT INNOVATIONS LLP3 Filed as: BENEFIT INNOVATIONS LLC | 5567 MADISON AVE HUDSONVILLE, MI 49426 | CONTINENTAL AMERICAN INSURANCE COMPANY | $160 | — | $160 | 0.39% |
| MIKE S GAYNOR3 | 625 KENMOOR AVE SE STE 200 GRAND RAPIDS, MI 49546 | CONTINENTAL AMERICAN INSURANCE COMPANY | $56 | — | $56 | 0.14% |
| K HARRIS & ASSOCIATES, LLC3 | 950 W. NORTON AVE STE 201 MUSKEGON, MI 49441 | CONTINENTAL AMERICAN INSURANCE COMPANY | $40 | — | $40 | 0.10% |
| HEATHER A DOLLIVER3 | 212 W SILVER LAKE ROAD FENTON, MI 48430 | CONTINENTAL AMERICAN INSURANCE COMPANY | $32 | — | $32 | 0.08% |
| CHRIS D BOULDREY3 | 340 WOOD HILLS DRIVE CONCORD, MI 49237 | CONTINENTAL AMERICAN INSURANCE COMPANY | $25 | — | $25 | 0.06% |
| JAMES C SNIDER JR3 Filed as: JAMES C SNIDER | 830 JUANITA RAEL WINTER PARK, FL 32789 | CONTINENTAL AMERICAN INSURANCE COMPANY | $25 | — | $25 | 0.06% |
| JIM M BULLOCK3 | 3715 POWDERHORN DR. OKEMOS, MI 48864 | CONTINENTAL AMERICAN INSURANCE COMPANY | $19 | — | $19 | 0.05% |
| STEPHANIE L KESSELRING3 | 4112 W OAKELLAR AVE TAMPA, FL 33611 | CONTINENTAL AMERICAN INSURANCE COMPANY | $12 | — | $12 | 0.03% |
| JEFFREY C WERNER3 | 18096 TRUDY DR SPRING LAKE, MI 49456 | CONTINENTAL AMERICAN INSURANCE COMPANY | $11 | — | $11 | 0.03% |
| AG AND ASSOCIATES3 | 2150 ASSOCIATION DRIVE STE 150 OKEMOS, MI 48864 | CONTINENTAL AMERICAN INSURANCE COMPANY | $9 | — | $9 | 0.02% |
| AG AND ASSOCIATES3 | 2150 ASSOCIATION DRIVE STE 150 OKEMOS, MI 48864 | CONTINENTAL AMERICAN INSURANCE COMPANY | $8 | — | $8 | 0.02% |
| JULIE SLAUGHTER3 | 430 BOARDWALK WALLED LAKE, MI 48390 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | NATIONAL VISION ADMINISTRATORS, LLC | $1K | — | $1K | 10.00% |
| WILLIAM DAVID BARHAM3 | 450 MORRIS AVE STE 201 MUSKEGON, MI 49440 | AFLAC | $507 | — | $507 | 5.40% |
| STEVEN MILLER3 | 89 MONROE CENTER ST NW STE 200 GRAND RAPIDS, MI 49503 | AFLAC | $85 | — | $85 | 0.91% |
| ERIC J CONDRON3 | 11358 WILD POND DR SE ROCKFORD, MI 49341 | AFLAC | $80 | — | $80 | 0.85% |
| JEREMY KOOI3 Filed as: JEREMY KOOL | 3495 HUNTER HOLLOW RD DODGEVILLE, WI 53533 | AFLAC | $76 | — | $76 | 0.81% |
| LEANN P DAVIDSON3 | 871 E MCKINLEY RD ROTHBURY, MI 49452 | AFLAC | $49 | — | $49 | 0.52% |
| WILLIAM DAVID BARHAM3 | 450 MORRIS AVE STE 201 MUSKEGON, MI 49440 | AFLAC | $43 | — | $43 | 0.46% |
| KEVIN L ERB3 | 5080 DOWLING ST MONTAGUE, MI 49437 | AFLAC | $35 | — | $35 | 0.37% |
| CAROL A SMYTHE3 | 915 LAKE AVENUE NORTH MUSKEGON, MI 49445 | AFLAC | $26 | — | $26 | 0.28% |
| BRUCE P VAN ANTWERP3 | 2578 BYRON RD HUDSONVILLE, MI 49426 | AFLAC | $24 | — | $24 | 0.26% |
| RANDALL L KIMBLER3 | PO BOX 302 HESPERIA, MI 49421 | AFLAC | $20 | — | $20 | 0.21% |
| ANDREW K GLAUB3 | 6155 GRAEBEAR TRL EAST LANSING, MI 48823 | AFLAC | $20 | — | $20 | 0.21% |
| JASON SCZEPANIAK3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | AFLAC | $18 | — | $18 | 0.19% |
| NORTHSTAR AGENCY LLC3 | 2582 ODAWA TRL MUSKEGON, MI 49444 | AFLAC | $13 | — | $13 | 0.14% |
| BRUCE A VAN RYN3 | 3053 RIVERVALE DR SW GRANDVILLE, MI 49418 | AFLAC | $10 | — | $10 | 0.11% |
| JEFFREY W XAVER3 | 5300 EAGLES NEST LN LELAND, MI 49654 | AFLAC | $10 | — | $10 | 0.11% |
| SPAZ AND GLAUB ENTERPRISES3 | PO BOX 339 BELLAIRE, WI 49615 | AFLAC | $9 | — | $9 | 0.10% |
| ERIC J CONDRON3 | 10880 SANDY OAK TRL CEDAR SPRINGS, MI 49319 | AFLAC | $8 | — | $8 | 0.09% |
| AG AND ASSOCIATES3 | 6155 GRAEBEAR TRL EAST LANSING, MI 48823 | AFLAC | $8 | — | $8 | 0.09% |
| JAMES C SNIDER JR3 | 457 MANOR RD MAITLAND, FL 32751 | AFLAC | $4 | — | $4 | 0.04% |
| HEIDI E GLAUB3 | 4404 SAINT ANDREWS ST HOWELL, MI 48843 | AFLAC | $3 | — | $3 | 0.03% |
| ALAN BERGMANN3 | 2144 MADERO DR THE VILLAGES, FL 32159 | AFLAC | $2 | — | $2 | 0.02% |
| CHRISTOPHER D BOULDREY3 | PO BOX 602 CONCORD, MI 49237 | AFLAC | $1 | — | $1 | 0.01% |
| JAMES BULLOCK3 | 3715 POWDERHORN DR OKEMOS, MI 48864 | AFLAC | $1 | — | $1 | 0.01% |
| THOMAS W RINGWALD3 | 37231 N 110TH ST SCOTTSDALE, AZ 85262 | AFLAC | $1 | — | $1 | 0.01% |
| STEPHANIE L KESSELRING3 | 3141 ROLLING GREEN CT MILFORD, MI 48380 | AFLAC | — | — | $0 | 0.00% |
| HEATHER A DOLLIVER3 | 2150 ASSOCIATION DR OKEMOS, MI 48864 | AFLAC | — | — | $0 | 0.00% |
| JEFFREY C WERNER3 | 6370 PINE HOLLOW DR EAST LANSING, MI 48823 | AFLAC | — | — | $0 | 0.00% |
| ANNIE GLAUB3 | 6155 GRAEBEAR TRL EAST LANSING, MI 48823 | AFLAC | — | — | $0 | 0.00% |
| MICHELLE R CALVIN3 | PO BOX 99 JONESVILLE, MI 49250 | AFLAC | — | — | $0 | 0.00% |
| DOUGLAS L DERKS3 | 2 PIERCE PLACE FLOOR 14TH ITASCA, IL 60143 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $1K | $6K | $7K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DOUGLAS DERKS INSURANCE AGENT | Other fees; Insurance brokerage commissions and fees; Insurance agents and brokers; Non-monetary compensation; Other commissions Service code 22 | 2 PIERCE PL 14TH FLOOR ITASCA, IL 60143 | $52K |
| GALLAGHER BENEFIT SERVICES INC BROKER | Insurance brokerage commissions and fees; Insurance agents and brokers; Non-monetary compensation; Other fees; Other commissions Service code 22 | 30150 TELEGRAPH STE 408 BINGHAM FARMS, MI 48025 | $23K |
| BLUE CROSS AND BLUE SHIELD OF MI EIN 38-2069753 TPA | Consulting (general); Float revenue; Claims processing; Direct payment from the plan; Insurance services; Other fees; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $7K |
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 | 212 | 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) | 212 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PRIORITY HEALTH | 355 | $1.5M |
| Dental | BLUE CROSS BLUE SHIELD OF MICHIGAN | 156 | $0 |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 301 | $15K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 495 | $173K |
| Short-term disability(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 495 | $182K |
| Long-term disability(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 495 | $182K |
| Prescription drug | PRIORITY HEALTH | 355 | $1.5M |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 495 | $173K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 495 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.