Form 5500 · Employee benefit plan · GRAND RAPIDS, MI
D.A. BLODGETT-ST JOHNS
The filing calls this plan D.A. BLODGETT-ST JOHN'S EMPLOYEE BENEFIT PLAN.
D.A. BLODGETT-ST JOHNS of GRAND RAPIDS, MI insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is JOHN SCHUEMANN. Coverage is written through BLUE CARE NETWORK OF MICHIGAN and 4 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 38-1358163 · plan 502 · plan year 2025, filed Jun 8, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 6 insured contracts covering health, dental, vision, life and disability; the largest, with BLUE CARE NETWORK OF MICHIGAN, covers 188 people.
Reported premium across the insured contracts is $1,279,486, with $48,090 in disclosed broker commissions — about 3.8% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
JOHN SCHUEMANN is the broker of record on 1 of the 6 contracts; the rest name a different broker or none.
5 carriers appear on the filing, including BLUE CARE NETWORK OF MICHIGAN, DELTA DENTAL OF MICHIGAN, THE LINCOLN NATIONAL LIFE INSURANCE COMPANY and VISION SERVICE PLAN. BLUE CARE NETWORK OF MICHIGAN writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CARE NETWORK OF MICHIGAN | Health | 188 | Jan 1, 2026 | $1,138,081 | $38,018 |
| DELTA DENTAL OF MICHIGAN | Dental | 193 | Jan 1, 2026 | $93,128 | $4,421 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | Disability | 131 | Jan 1, 2026 | $16,711 | $2,506 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | Life | 131 | Jan 1, 2026 | $13,920 | $2,088 |
| VISION SERVICE PLAN | Vision | 80 | Jan 1, 2026 | $14,239 | $712 |
| HARTFORD LIFE AND ACCIDENT | Life, Disability | 133 | Jan 1, 2026 | $3,407 | $345 |
Premium and claims on these contracts
BLUE CARE NETWORK OF MICHIGAN, contract 245482. For the contract year on this filing, the carrier reported $1,138,081 in premium earned and $809,961 in claims incurred. Dividing one by the other gives 71%.
DELTA DENTAL OF MICHIGAN, contract 5109. For the contract year on this filing, the carrier reported $93,128 in premium earned and $78,228 in claims incurred. Dividing one by the other gives 84%.
- BLUE CARE NETWORK OF MICHIGAN, contract 245482 reported $296,854 in retention.
- DELTA DENTAL OF MICHIGAN, contract 5109 reported $13,587 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Reported to OSHA
Reported to OSHA for 2025: 163 employees, 11 recordable cases, 23 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
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