| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRICK LUKASIK3 | 42203 ANN ARBOR RD E PLYMOUTH, MI 48170 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $25K | $2K | $28K | 1.32% |
| PAMELA HILLIER3 | 300 S FRONT STREET MARQUETTE, MI 49855 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $9K | $0 | $9K | 0.45% |
| PATRICK LUKASIK3 | 43027 FERNWOOD CANTON, MI 48187 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $10K | $0 | $10K | 2.94% |
| ACRISURE LLC3 | 220 SOUTH WALNUT STREET MUNCIE, IN 47305 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $9K | $0 | $9K | 2.80% |
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 | 166 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 170 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 510 | $2.1M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 496 | $337K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 496 | $337K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 496 | $337K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 496 | $337K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 510 | $2.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 510 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.