| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MICHAEL G. GREEN3 Filed as: MICHAEL GREEN | 30150 TELEGRAPH ROAD SUITE 408 FRANKLIN, MI 48025 | PRIORITY HEALTH INSURANCE COMPANY | $21K | — | $21K | 2.04% |
| ANGELA M DEAN3 Filed as: ANGELA DEAN | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | PRIORITY HEALTH INSURANCE COMPANY | $5K | — | $5K | 0.46% |
| MICHAEL G. GREEN3 Filed as: MICHAEL GREEN | 30150 TELEGRAPH ROAD SUITE 408 FRANKLIN, MI 48025 | PRIORITY HEALTH | $14K | — | $14K | 2.28% |
| ANGELA M DEAN3 Filed as: ANGELA DEAN | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | PRIORITY HEALTH | $3K | — | $3K | 0.48% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2800 LIVERNOIS ROAD SUITE 275 TROY, MI 48083 | DELTA DENTAL OF OHIO | $5K | — | $5K | 3.70% |
| KAPNICK & COMPANY, INC.3 | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 48108 | DELTA DENTAL OF OHIO | $2K | — | $2K | 1.26% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 30150 TELEGRAPH ROAD SUITE 408 BINGHAM FARMS, MI 48025 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $212 | $2K | 4.89% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC. | 333 INDUSTRIAL DRIVE P.O. BOX 1801 ADRIAN, MI 49221 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $246 | — | $246 | 0.77% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 30150 TELEGRAPH ROAD SUITE 408 BINGHAM FARMS, MI 48025 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $162 | $1K | 4.70% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC. | 333 INDUSTRIAL DRIVE P.O. BOX 1801 ADRIAN, MI 49221 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $255 | — | $255 | 0.81% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 30150 TELEGRAPH ROAD SUITE 408 BINGHAM FARMS, MI 48025 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $931 | $128 | $1K | 4.78% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC. | 333 INDUSTRIAL DRIVE P.O. BOX 1801 ADRIAN, MI 49221 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $177 | — | $177 | 0.80% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | P.O. BOX 3009 ARLINGTON HEIGHTS, IL 60006 | GERBER | $1K | — | $1K | 6.56% |
| KAPNICK & COMPANY, INC.3 | DBA KAPNICK INSURANCE GROUP 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | GERBER | $524 | — | $524 | 3.43% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 30150 TELEGRAPH ROAD SUITE 408 BINGHAM FARMS, MI 48025 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $165 | $23 | $188 | 4.80% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC. | 333 INDUSTRIAL DRIVE P.O. BOX 1801 ADRIAN, MI 49221 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $31 | — | $31 | 0.79% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2800 SOUTH TELEGRAPH ROAD SUITE 100 BLOOMFIELD HILLS, MI 48302 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $581 | — | $581 | 16.96% |
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 | 177 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 179 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | PRIORITY HEALTH INSURANCE COMPANY | 229 | $1.6M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF OHIO | 419 | $134K |
| Vision(2 contracts, 2 carriers) | GERBER | 443 | $20K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 177 | $32K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 177 | $32K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 177 | $22K |
| Prescription drug(3 contracts, 3 carriers) | PRIORITY HEALTH INSURANCE COMPANY | 229 | $1.6M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 177 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 443 | — |
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."
No prospect flags tripped on this filing.