| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EVE ROGUS3 | 56 GRANDVILLE AVE, SUITE 300 GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $41K | — | $41K | 2.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MID-AMERICA | 6100 S YALE AVE SUITE 1900 TULSA, OK 74136 | COMMUNITY CARE | — | $5K | $5K | 2.22% |
| ASSOCIATED FINANCIAL GROUP LLC3 Filed as: ASSOCIATED FINANCIAL GROUP | 711 EISENHOWER DR. KIMBERLY, WI 54136 | HARTFORD LIFE AND ACCIDENT | $7K | — | $7K | 6.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL PLAN BENEFIT ANAL | 6100 S YALE AVE SUITE 1900 TULSA, OK 74136 | DELTA DENTAL | $664 | $402 | $1K | 12.85% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE EIN 36-2739571 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $1.4M |
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 | 3,492 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 614 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 4,106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | PRIORITY HEALTH | 403 | $3.2M |
| Dental | DELTA DENTAL | 8 | $8K |
| Prescription drug(2 contracts, 2 carriers) | PRIORITY HEALTH | 371 | $2.2M |
| Other | HARTFORD LIFE AND ACCIDENT | 444 | $119K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 444 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.