| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DOUGLAS CALKINS3 | 56 GRANDVILLE AVE, SUITE 300 GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $43K | — | $43K | 1.70% |
| EVE ROGUS3 | 56 GRANDVILLE AVE, SUITE 300 GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $8K | — | $8K | 0.30% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $78K | $33K | $111K | 6.44% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $8K | $2K | $10K | 7.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE EIN 36-2739571 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $1.8M |
| USI INSURANCE SERVICES LLC EIN 13-3771734 BROKER | Other commissions Service code 55 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | $13K |
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 | 3,398 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 712 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 4,110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PRIORITY HEALTH | 411 | $3.4M |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 3,956 | $1.7M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 3,956 | $1.7M |
| Prescription drug | PRIORITY HEALTH | 346 | $2.5M |
| Other | HARTFORD LIFE AND ACCIDENT | 3,360 | $140K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,956 | — |
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.