| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DOUGLAS L DERKS3 | 2600 S TELEGRAPH STE 100 BLOOMFIELD HILLS, MI 483028302 | BLUE CARE NETWORK OF MICHIGAN | $58K | — | $58K | 2.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 2600 S TELEGRAPH STE 100 BLOOMFIELD HILLS, MI 483028302 | BLUE CARE NETWORK OF MICHIGAN | — | $2K | $2K | 0.12% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 2600 S TELEGRAPH RD, STE 100 BLOOMFIELD HILLS, MI 483020968 | METROPOLITAN LIFE INSURANCE COMPANY | $26K | — | $26K | 10.82% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 600063009 | METROPOLITAN LIFE INSURANCE COMPANY | — | $4K | $4K | 1.73% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | PO BOX 95287 CHICAGO, IL 606945287 | METROPOLITAN LIFE INSURANCE COMPANY | — | $8 | $8 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 7.28% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 W GOLF RD 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 1.96% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 12.35% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 W GOLF RD 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $661 | — | $661 | 1.96% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | NATIONAL VISION ADMINISTRATORS, LLC | $2K | — | $2K | 10.00% |
| KENNETH EUGENE MCCALLUM3 | 776 HILL AVE MUSKEGON, MI 49442 | AFLAC | $552 | — | $552 | 5.97% |
| WILLIAM DAVID BARHAM3 | 2039 RAMBLING OAK DR MUSKEGON, MI 49415 | AFLAC | $393 | — | $393 | 4.25% |
| STEVEN MILLER3 | 89 MONROE CENTER ST NW STE 200 GRAND RAPIDS, MI 49503 | AFLAC | $79 | — | $79 | 0.85% |
| JEREMY KOOI3 Filed as: JEREMY KOOL | 170 STATE ROAD 23 MINERAL POINT, WI 53565 | AFLAC | $70 | — | $70 | 0.76% |
| WILLIAM JOHNSON & ASSOC LLC3 | 2922 FULLER AVE NE 202 GRAND RAPIDS, MI 49505 | AFLAC | $70 | — | $70 | 0.76% |
| ERIC J CONDRON3 | 10880 SANDY OAK TRL CEDAR SPRINGS, MI 49319 | AFLAC | $69 | — | $69 | 0.75% |
| LEANN P DAVIDSON3 | 204 W SKEELS RD MONTAGUE, MI 49437 | AFLAC | $40 | — | $40 | 0.43% |
| WILLIAM DAVID BARHAM3 | 2039 RAMBLING OAK DR MUSKEGON, MI 49445 | AFLAC | $36 | — | $36 | 0.39% |
| KEVIN L ERB3 | 5080 DOWLING ST MONTAGUE, MI 49437 | AFLAC | $32 | — | $32 | 0.35% |
| CAROL A SMYTHE3 | 915 LAKE AVENUE NORTH MUSKEGON, MI 49445 | AFLAC | $24 | — | $24 | 0.26% |
| BRUCE P VAN ANTWERP3 | 2578 BYRON RD HUDSONVILLE, MI 49426 | AFLAC | $22 | — | $22 | 0.24% |
| RANDALL L KIMBLER3 | PO BOX 302 HESPERIA, MI 49421 | AFLAC | $18 | — | $18 | 0.19% |
| JASON SCZEPANIAK3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | AFLAC | $16 | — | $16 | 0.17% |
| ANDREW K GLAUB3 | PO BOX 339 BELLAIRE, MI 49615 | AFLAC | $15 | — | $15 | 0.16% |
| BRUCE A VAN RYN3 | 3053 RIVERVALE DR SW GRANDVILLE, MI 49418 | AFLAC | $10 | — | $10 | 0.11% |
| SPAZ AND GLAUB ENTERPRISES3 | PO BOX 339 BELLAIRE, WI 49615 | AFLAC | $9 | — | $9 | 0.10% |
| SANDRA L NASS3 | 2582 ODAWA TRL MUSKEGON, MI 49444 | AFLAC | $8 | — | $8 | 0.09% |
| JEFFREY W XAVER3 | PO BOX 809 LELAND, MI 49654 | AFLAC | $7 | — | $7 | 0.08% |
| AG AND ASSOCIATES3 | PO BOX 339 BELLAIRE, MI 49615 | AFLAC | $7 | — | $7 | 0.08% |
| NORTHSTAR AGENCY LLC3 | 2582 ODAWA TRL MUSKEGON, MI 49444 | AFLAC | $3 | — | $3 | 0.03% |
| HEIDI E GLAUB3 | 4404 SAINT ANDREWS ST HOWELL, MI 48843 | AFLAC | $3 | — | $3 | 0.03% |
| JAMES C SNIDER JR3 | 20817 POINTE REGATTA DR CORNELIUS, NC 28031 | AFLAC | $3 | — | $3 | 0.03% |
| ALAN BERGMANN3 | 461 COKESBURY DR THE VILLAGES, FL 32162 | AFLAC | $2 | — | $2 | 0.02% |
| CHRISTOPHER D BOULDREY3 | 448 RIVER WOODS DR FLUSHING, MI 48433 | AFLAC | $1 | — | $1 | 0.01% |
| JAMES BULLOCK3 | 6144 W LONGVIEW DR EAST LANSING, MI 48823 | AFLAC | $1 | — | $1 | 0.01% |
| THOMAS W RINGWALD3 | 37231 N 110TH ST SCOTTSDALE, AZ 85262 | AFLAC | $1 | — | $1 | 0.01% |
| DOUGLAS L DERKS3 | 2850 GOLD ROAD ROLLING MEADOWS, IL 60008 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $6K | $6K | — |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 30150 TELEGRAPH RD STE 408 BINGHAM FARMS, MI 48025 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $924 | $924 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DOUGLAS DERKS INSURANCE AGENT | Non-monetary compensation; Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees; Other fees Service code 22 | 2850 GOLD ROAD ROLLING MEADOWS, IL 60008 | $64K |
| GALLAGHER BENEFIT SERVICES INC BROKER | Insurance agents and brokers; Other fees; Non-monetary compensation; Insurance brokerage commissions and fees; Other commissions Service code 22 | 2600 S TELEGRAPH RD BLOOMFIELD HILLS, MI 483020968 | $51K |
| BLUE CROSS AND BLUE SHIELD OF MI EIN 38-2069753 TPA | Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general); Contract Administrator; Direct payment from the plan; Other fees; Claims processing; Insurance services; Float revenue Service code 12 | — | $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 | 268 | 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) | 268 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CARE NETWORK OF MICHIGAN | 439 | $2.0M |
| Dental | BLUE CROSS BLUE SHIELD OF MICHIGAN | 508 | $0 |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 449 | $19K |
| Life insurance(3 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 544 | $390K |
| Short-term disability(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 544 | $366K |
| Long-term disability(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 544 | $366K |
| Prescription drug | BLUE CARE NETWORK OF MICHIGAN | 439 | $2.0M |
| Other(3 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 544 | $390K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 544 | — |
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.