| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GREG M. GOODMAN (TIC INTERNATIONAL3 | 11590 N. MERIDIAN, STE 600 CARMEL, IN 46032 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $15K | — | $15K | 3.50% |
| TIC INTERNATIONAL CORPORATION3 | 11590 N. MERIDIAN, STE 600 CARMEL, IN 46032 | GUARDIAN LIFE INSURANCE COMPANY | $6K | — | $6K | 8.26% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIED OF MICHIGAN EIN 38-2069753 NONE | Other fees; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Insurance services; Consulting (general); Contract Administrator; Direct payment from the plan Service code 12 | — | $768K |
| SEGAL CONSULTING EIN 13-1835864 NONE | Consulting (general) Service code 16 | — | $109K |
| TIC INTERNATIONAL CORPORATION EIN 13-2600875 NONE | Copying and duplicating; Claims processing; Accounting (including auditing); Contract Administrator Service code 10 | — | $90K |
| MARQUETTE ASSOCIATES EIN 36-3485298 NONE | Investment advisory (plan) Service code 27 | — | $72K |
| LEGGHIO & ISRAEL, PC EIN 38-1971448 NONE | Legal Service code 29 | — | $68K |
| DELTA DENTAL OF MICHIGAN EIN 38-1791480 NONE | Claims processing Service code 12 | — | $37K |
| CALIBRE CPA GROUP,PLLC EIN 47-0900880 NONE | Accounting (including auditing) Service code 10 | — | $28K |
| VISION SERVICE PLAN EIN 06-1227840 NONE | Claims processing; Contract Administrator Service code 12 | — | $14K |
| BANK OF LABOR EIN 48-0150325 NONE | Custodial (securities) Service code 19 | — | $8K |
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 | 7,578 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 704 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 8,282 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | GUARDIAN LIFE INSURANCE COMPANY | 738 | $68K |
| Short-term disability | GUARDIAN LIFE INSURANCE COMPANY | 738 | $68K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY | 738 | $68K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 2,378 | $430K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,378 | — |
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.