| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC. | 333 BRIDGE ST NW STE 710 GRAND RAPIDS, MI 49504 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $152K | — | $152K | 3.26% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC. | 775 YARD STREET COLUMBUS, OH 43212 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $2K | $2K | 0.04% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC. | 333 BRIDGE ST NW STE 710 GRAND RAPIDS, MI 49504 | BLUE CARE NETWORK OF MICHIGAN | $17K | — | $17K | 2.75% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 333 BRIDGE ST NW STE 710 GRAND RAPIDS, MI 49504 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $25K | — | $25K | 4.42% |
| FMLASOURCE INC5 | 455 N CITYFRONT PLZ DR 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $7K | $7K | 1.27% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC. | 330 W COLLEGE AVE APPLETON, WI 54911 | DELTA DENTAL OF MICHIGAN | $9K | — | $9K | 2.49% |
| WILLIS TOWERS WATSON US LLC4 Filed as: WILLIS OF NORTH AMERICA | CHURCH STREET PO BOX 4557 NEW YORK, NY 10249 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $1K | — | $1K | 17.00% |
| SCOTT BECK4 | APT 13G 6 PETER COOPER RD NEW YORK, NY 10010 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $132 | — | $132 | 2.00% |
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 | 627 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 36 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 671 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 793 | $5.3M |
| Dental | DELTA DENTAL OF MICHIGAN | 887 | $345K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 793 | $4.7M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 634 | $572K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 634 | $572K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 793 | $5.3M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 634 | $579K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 887 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.