| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARC D. DEVISSER3 Filed as: MARC DURAND DEVISSER | 50 LOUIS STREET NW, SUITE 200 GRAND RAPID, MI 49503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $16K | $4K | $20K | 1.62% |
| BRENDA R MANNING3 Filed as: BRENDA R. MANNING | PO BOX 2167 16805 WEST CLEVELEND AVENUE NEW BERLIN, WI 53151 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $14K | $0 | $14K | 1.16% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | PO BOX 510187 NEW BERLIN, WI 53151 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $0 | $4K | 10.70% |
| LOCKTON COMPANIES, LLC3 | 500 WEST MONROE STREET, SUITE 3400 CHICAGO, IL 60661 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $57 | $57 | 0.14% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $1 | $1 | 0.00% |
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 | 143 | 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) | 143 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 286 | $1.2M |
| Dental(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 143 | $0 |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 143 | $0 |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 141 | $40K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 141 | $40K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 286 | $1.2M |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 141 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 286 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.