| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASR HEALTH BENEFITS3 | P.O. BOX 6392 3033 ORCHARD VISTA S.E. GRAND RAPIDS, MI 49516 | SIRIUS AMERICA | $7K | $0 | $7K | 3.00% |
| TRICOAST ADVISORS LLC3 | 50 LOUIS ST NW STE 510 GRAND RAPIDS, MI 49503 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 8.92% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 4.08% |
| TRICOAST ADVISORS LLC3 | 50 LOUIS ST NW STE 510 GRAND RAPIDS, MI 49503 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 15.00% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 4.02% |
| TRICOAST ADVISORS LLC3 | 50 LOUIS ST NW STE 510 GRAND RAPIDS, MI 49503 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 13.99% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $760 | $760 | 4.04% |
| TRICOAST ADVISORS LLC3 | 50 LOUIS ST NW, STE 510 GRAND RAPIDS, MI 49503 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 10.00% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $576 | $576 | 4.05% |
| TRICOAST ADVISORS LLC3 | 50 LOUIS ST NW STE 510 GRAND RAPIDS, MI 49503 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 15.00% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $467 | $467 | 3.99% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | 140 MONROE CTR ST NW STE 200 GRAND RAPIDS, MI 495032893 | VISION SERVICE PLAN | $762 | $0 | $762 | 7.36% |
| TRICOAST ADVISORS LLC3 | 50 LOUIS ST STE 510 GRAND RAPIDS, MI 49503 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $930 | $0 | $930 | 15.00% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $247 | $247 | 3.98% |
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 | 152 | 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) | 152 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SIRIUS AMERICA | 113 | $241K |
| Vision | VISION SERVICE PLAN | 69 | $10K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 55 | $25K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 152 | $38K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 152 | $19K |
| Stop-loss / reinsurancereinsurance | SIRIUS AMERICA | 113 | $241K |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 152 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 152 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.