| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS AGENCY | 3055 44TH ST SW GRANDVILLE, MI 49418 | PRIORITY HEALTH | $20K | — | $20K | 1.59% |
| HNI RISK SERVICES3 | 140 MONROE CENTER STREET NW GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $5K | — | $5K | 0.43% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS AGENCY | 3055 44TH ST SW GRANDVILLE, MI 49418 | PRIORITY HEALTH INSURANCE COMPANY | $3K | — | $3K | 1.53% |
| HNI RISK SERVICES3 | 140 MONROE CENTER STREET NW GRAND RAPIDS, MI 49503 | PRIORITY HEALTH INSURANCE COMPANY | $950 | — | $950 | 0.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS AGENCY | 3055 44TH ST SW GRANDVILLE, MI 49418 | DELTA DENTAL OF MICHIGAN | $3K | $107 | $3K | 4.80% |
| HNI RISK SERVICES3 | 140 MONROE CENTER STREET NW GRAND RAPIDS, MI 49503 | DELTA DENTAL OF MICHIGAN | $980 | — | $980 | 1.41% |
| JON A RYBICKI3 | 71 129TH AVE WAYLAND, MI 49348 | AFLAC | $5K | $188 | $5K | 9.38% |
| WILLIAM JOHNSON & ASSOC LLC3 | 1755 INDIAN LAKES RD CEDAR SPRINGS, MI 49319 | AFLAC | $1K | $42 | $1K | 2.46% |
| EDWARD O WALTER III3 Filed as: EDWARD 0 WALTER III | PO BOX 1377 NOVI, MI 48376 | AFLAC | $528 | — | $528 | 0.94% |
| MARY EVELYN LEGGETT3 | 522 MAPLE ST ALLEGAN, MI 49010 | AFLAC | $352 | — | $352 | 0.63% |
| RAY W HINKLE3 | 1525 PLYMOUTH AVE SE GRAND RAPIDS, MI 49506 | AFLAC | $245 | — | $245 | 0.44% |
| NICOLE DOLPHIN3 | 5314 QUEST DR SW WYOMING, MI 49418 | AFLAC | $180 | $42 | $222 | 0.40% |
| MERRI C SMITH3 | 492 142ND AVE CALEDONIA, MI 49316 | AFLAC | $93 | — | $93 | 0.17% |
| MARY E WILLS3 | 9257 CLEVELAND ST APT 102 MERRILLVILLE, IN 46410 | AFLAC | $52 | — | $52 | 0.09% |
| DANIEL JAY BOONE3 | 1146 GLENWOOD ST JENISON, MI 49428 | AFLAC | $51 | — | $51 | 0.09% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS AGENCY | 3055 44TH ST SW GRANDVILLE, MI 49418 | AFLAC | $38 | — | $38 | 0.07% |
| TJY BENEFITS CORPORATION3 | 6737 BLUE HUMMINGBIRD WAY NE BELDING, MI 48809 | AFLAC | $38 | — | $38 | 0.07% |
| JEFFREY C WERNER3 Filed as: JEFFREY WERNER LLC | 4430 GLENCOE DR WILLIAMSTON, MI 48895 | AFLAC | $30 | — | $30 | 0.05% |
| THOMAS S WICKEY3 | 3497 LONG GROVE DR SE KENTWOOD, MI 49512 | AFLAC | $27 | — | $27 | 0.05% |
| CHARLES V GLAUB3 | 4404 SAINT ANDREWS ST HOWELL, MI 48843 | AFLAC | $22 | — | $22 | 0.04% |
| SANTIAGO & ASSOCIATES LLC3 | 5480 PINE BLUFF LN MUSKEGON, MI 49441 | AFLAC | $21 | — | $21 | 0.04% |
| ANNA LORELEI WIERENGA3 | 12860 VALLEY DR WAYLAND, MI 49348 | AFLAC | $17 | — | $17 | 0.03% |
| MATTHEW P JOHNSON3 | 1002 W GRAND RIVER AVE WILLIAMSTON, MI 48895 | AFLAC | $15 | — | $15 | 0.03% |
| STEPHANIE L KESSELRING3 | 5434 OAKHURST DR SEMINOLE, FL 33772 | AFLAC | $10 | — | $10 | 0.02% |
| ELWYN D JOSLIN3 | PO BOX 197 CEDAR SPRINGS, MI 49319 | AFLAC | $10 | — | $10 | 0.02% |
| AG AND ASSOCIATES3 Filed as: AG & ASSOCIATES | PO BOX 339 BELLAIRE, MI 49615 | AFLAC | $9 | — | $9 | 0.02% |
| JEREMY D SAMPSEL3 | 10438 N 6TH ST OTSEGO, MI 49078 | AFLAC | $8 | — | $8 | 0.01% |
| RANDALL L KIMBLER3 | PO BOX 302 HESPERIA, MI 49421 | AFLAC | $7 | — | $7 | 0.01% |
| DOUGLAS E FOX3 | 6836 THAYER LAKE DR ALDEN, MI 49612 | AFLAC | $7 | — | $7 | 0.01% |
| HEATHER A DOLLIVER3 | 2150 ASSOCIATION DR OKEMOS, MI 48864 | AFLAC | $6 | — | $6 | 0.01% |
| JON MARTIN KETCHAM3 | 1947 142ND AVE DORR, MI 49323 | AFLAC | $6 | — | $6 | 0.01% |
| JASON SCZEPANIAK3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | AFLAC | $4 | — | $4 | 0.01% |
| WESLEY A SMITH3 | 8522 CURLEY TRL SE CALEDONIA, MI 49316 | AFLAC | $3 | — | $3 | 0.01% |
| JAMES C SNIDER JR3 | 457 MANOR RD MAITLAND, FL 32751 | AFLAC | $3 | — | $3 | 0.01% |
| HEIDI E GLAUB3 | 4404 SAINT ANDREWS ST HOWELL, MI 48843 | AFLAC | $2 | — | $2 | 0.00% |
| THOMAS W BOSTON3 Filed as: THOMAS W RINGWALD | 37231 N 110TH ST SCOTTSDALE, AZ 85262 | AFLAC | $2 | — | $2 | 0.00% |
| JAMES BULLOCK3 | 3715 POWDERHORN DR OKEMOS, MI 48864 | AFLAC | $2 | — | $2 | 0.00% |
| ANDREW K GLAUB3 | PO BOX 339 BELLAIRE, MI 49615 | AFLAC | $1 | — | $1 | 0.00% |
| CHRISTOPHER D BOULDREY3 | PO BOX 602 CONCORD, MI 49237 | AFLAC | $1 | — | $1 | 0.00% |
| CAROL J THOMPSON3 | 51717 SUMMER WOOD CT GRANGER, IN 46530 | AFLAC | $1 | — | $1 | 0.00% |
| MATTHEW M NACHAZEL3 | 16473 BAYWOOD LN GRANGER, IN 46530 | AFLAC | $1 | — | $1 | 0.00% |
| ANNIE GLAUB3 | PO BOX 339 BELLAIRE, MI 49615 | AFLAC | $1 | — | $1 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS AGENCY | 3055 44TH ST SW GRANDVILLE, MI 49418 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $679 | $5K | 10.25% |
| HNI RISK SERVICES3 | 140 MONROE CENTER STREET NW GRAND RAPIDS, MI 49503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 4.39% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BERENDS HENDRICKS STUIT INS AGENCY | 3055 44TH ST SW GRANDVILLE, MI 49418 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | — | $1K | 8.56% |
| HNI RISK SERVICES3 | 140 MONROE CENTER STREET NW GRAND RAPIDS, MI 49503 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $317 | — | $317 | 2.42% |
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 | 176 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 178 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PRIORITY HEALTH | 227 | $1.4M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF MICHIGAN | 257 | $125K |
| Vision(2 contracts, 2 carriers) | AFLAC | 213 | $69K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 181 | $51K |
| Short-term disability | AFLAC | 47 | $56K |
| Prescription drug(2 contracts, 2 carriers) | PRIORITY HEALTH | 227 | $1.4M |
| Other(2 contracts, 2 carriers) | AFLAC | 181 | $107K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 257 | — |
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.