| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STEVEN J HOPP Filed as: STEVEN J. HOPP | 3 SUMMIT PARK DR., STE 530 INDEPENDENCE, OH 44131 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $15K | $70K | $85K | 19.97% |
| GALLAGHER BENEFIT SERVICES, INC. | 1111 SUPERIOR AVE., E CLEVELAND, OH 44114 | DELTA DENTAL OF MICHIGAN | $6K | — | $6K | 3.06% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFIT SERVICES INC | 1100 SUPERIOR AVE., STE 1700 CLEVELAND, OH 441142521 | UNITED OF OMAHA LIFE INSURANCE CO | $7K | $2K | $8K | 14.77% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFIT SERVICES INC | 1100 SUPERIOR AVE., STE 1700 CLEVELAND, OH 441142521 | UNITED OF OMAHA LIFE INSURANCE CO | $6K | $1K | $7K | 15.04% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFIT SERVICES INC | 1100 SUPERIOR AVE., STE 1700 CLEVELAND, OH 441142521 | UNITED OF OMAHA LIFE INSURANCE CO | $3K | $813 | $4K | 12.63% |
| JAMES A SMAARDYK Filed as: JAMES M. TAYLOR | 3016 SPRING HILL PKWY, SE SMYRNA, GA 30080 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $170 | — | $170 | 2.19% |
| MARY LOU TAYLOR | 3016 SPRING HILL PKWY, SE SMYRNA, GA 30080 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $105 | — | $105 | 1.35% |
| DAVID L SMELCER Filed as: DAVID L. SMELCER | PO BOX 279 MAUMEE, OH 43537 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $39 | — | $39 | 0.50% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFIT SERVICES INC | 1100 SUPERIOR AVE., STE 1700 CLEVELAND, OH 441142521 | UNITED OF OMAHA LIFE INSURANCE CO | $809 | $191 | $1K | 14.83% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Contract Administrator; Direct payment from the plan; Other fees; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Insurance services; Claims processing Service code 12 | — | $152K |
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 | 241 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 242 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 242 | $425K |
| Dental | DELTA DENTAL OF MICHIGAN | 511 | $204K |
| Vision(2 contracts) | SVS VISION MANAGED CARE, INC. | 87 | $15K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE CO | 307 | $63K |
| Short-term disability(3 contracts) | UNITED OF OMAHA LIFE INSURANCE CO | 307 | $112K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE CO | 169 | $31K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 242 | $425K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 242 | $425K |
| Other | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 16 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 511 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.