| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROGUS, EVE3 | 56 GRANDVILLE AVE , SUITE 300 GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $40K | — | $40K | 2.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MID-AMERICA | 6100 S YALE AVE SUITE 1900 TULSA, OK 74136 | COMMUNITY CARE | — | $7K | $7K | 1.84% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LIMITED P | 5314 S. YALE SUITE 900 TULSA, OK 74135 | COMMUNITY CARE | — | $3K | $3K | 0.92% |
| ASSOCIATED FINANCIAL GROUP LLC3 Filed as: ASSOCIATED FINANCIAL GROUP | P O BOX 640 GREEN BAY, WI 543050640 | HARTFORD LIFE AND ACCIDENT | $7K | $2K | $8K | 7.37% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL PLAN BENEFIT ANAL | 6100 S YALE AVE SUITE 1900 TULSA, OK 74136 | DELTA DENTAL | $1K | — | $1K | 8.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITEDHEALTHCARE EIN 36-2739571 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $1.7M |
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 | 3,322 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 565 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 3,887 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | PRIORITY HEALTH | 395 | $3.2M |
| Dental | DELTA DENTAL | 18 | $16K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 3,074 | $112K |
| Prescription drug(2 contracts, 2 carriers) | PRIORITY HEALTH | 383 | $2.3M |
| Other | HARTFORD LIFE AND ACCIDENT | 3,074 | $112K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,074 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.