Form 5500 · Employee benefit plan · GRAND RAPIDS, MI
OWEN AMES KIMBALL CO
The filing calls this plan OWEN AMES KIMBALL CO EMPLOYEE BENEFIT PLAN.
OWEN AMES KIMBALL CO of GRAND RAPIDS, MI spreads its employee benefits across 3 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is MICHAEL HAGERTY. Coverage is written through BLUE CARE NETWORK OF MICHIGAN and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 38-0900420 · plan 501 · plan year 2024, filed Oct 13, 2025
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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 3 insured contracts covering health and life; the largest, with BLUE CARE NETWORK OF MICHIGAN, covers 465 people.
The filing declares health, life and dental. Dental appears with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.
Reported premium across the insured contracts is $2,532,266, with $78,705 in disclosed broker commissions — about 3.1% 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.
MICHAEL HAGERTY is the broker of record on 2 of the 3 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CARE NETWORK OF MICHIGAN | Health | 465 | Jan 1, 2025 | $2,416,646 | $74,322 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN | Health | 11 | Jan 1, 2025 | $106,974 | $3,322 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | Life | 232 | Jan 1, 2025 | $8,646 | $1,061 |
Premium and claims on these contracts
BLUE CARE NETWORK OF MICHIGAN, contract 174837. For the contract year on this filing, the carrier reported $2,416,646 in premium earned and $3,384,010 in claims incurred. Dividing one by the other gives 140%.
BLUE CROSS BLUE SHIELD OF MICHIGAN, contract 174837. For the contract year on this filing, the carrier reported $106,974 in premium earned and $27,318 in claims incurred. Dividing one by the other gives 26%.
- BLUE CARE NETWORK OF MICHIGAN, contract 174837 reported $611,708 in retention.
- BLUE CROSS BLUE SHIELD OF MICHIGAN, contract 174837 reported $27,147 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: 149 employees, 4 recordable cases, 0 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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