| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TRIENA M ATKINSON3 Filed as: TRIENA M. ATKINSON | 1591 GALBRAITH AVENUE SE GRAND RAPIDS, MI 49546 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $25K | $0 | $25K | 4.32% |
| TGG SOLUTIONS3 | 588 3 MILE ROAD NW, SUITE 101 GRAND RAPIDS, MI 49544 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $3K | $0 | $3K | 0.45% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 1560 ORANGE AVENUE, SUITE 750 WINTER PARK, FL 32789 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $0 | $8K | 5.91% |
| LEGACY PARTNERS II LLC3 Filed as: LEGACY PARTNERS II, LLC | 33304 GRAND RIVER AVENUE FARMINGTON, MI 48336 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $0 | $5K | 4.14% |
| LEGACY PARTNERS II LLC5 Filed as: LEGACY PARTNERS II, LLC | 39833 BRIDGEVIEW STREET HARRISON, MI 48045 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 1.65% |
| LEGACY PARTNERS II LLC3 Filed as: LEGACY PARTNERS II, LLC | 31300 PLYMOUTH ROAD LIVONIA, MI 48150 | DELTA DENTAL OF MICHIGAN | $6K | $0 | $6K | 6.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 1591 GALBRAITH AVENUE SE GRAND RAPIDS, MI 49546 | DELTA DENTAL OF MICHIGAN | $3K | $0 | $3K | 3.55% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 55 EAST JACKSON BOULEVARD CHICAGO, IL 60604 | DELTA DENTAL OF MICHIGAN | $2K | $0 | $2K | 2.48% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2167 GRAND RAPIDS, MI 49501 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $1K | $0 | $1K | 6.87% |
| LEGACY PARTNERS II LLC3 Filed as: LEGACY PARTNERS II, LLC | 33304 GRAND RIVER AVENUE FARMINGTON, MI 48336 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $526 | $0 | $526 | 3.25% |
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 | 118 | 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) | 118 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 207 | $572K |
| Dental | DELTA DENTAL OF MICHIGAN | 221 | $92K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 216 | $16K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 118 | $130K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 118 | $130K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 118 | $130K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 207 | $572K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 118 | $130K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 221 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.