| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KATHERINE C WOOD3 | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 481088108 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $40K | — | $40K | 3.00% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK AND COMPANY INC | PO BOX 1801 ADRIAN, MI 492219221 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $1K | $1K | 0.11% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK AND COMPANY INC. | 1201 BRIARWOOD CR ANN ARBOR, MI 48108 | DELTA DENTAL OF MICHIGAN | $6K | — | $6K | 9.20% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 1201 BRIARWOOD CR ANN ARBOR, MI 48108 | DELTA DENTAL OF MICHIGAN | $5K | — | $5K | 9.96% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DR ADRIAN, MI 49221 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $2K | $8K | 20.00% |
| KAPNICK & COMPANY, INC.3 | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $1K | $6K | 20.00% |
| KAPNICK & COMPANY, INC.3 | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $1K | $5K | 20.00% |
| KAPNICK & COMPANY, INC.3 | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $991 | $4K | 20.00% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK INSURANCE GROUP | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 48108 | EYEMED VISON CARE | $1K | — | $1K | 10.61% |
| TRACY KATZ LLC4 | 1662 E MELTON ROAD BIRMINGHAM, MI 48009 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $274 | — | $274 | 6.26% |
| GALLAGHER BENEFIT SERVICES, INC.4 Filed as: GALLAGHER BENEFIT SERVICES INC | 2600 SOUTH TELEGRAPH ROAD STE 100 BLOOMFIELD HILLS, MI 48302 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $159 | — | $159 | 3.63% |
| KAPNICK & COMPANY, INC.4 Filed as: KAPNICK INSURANCE GROUP | 233 INDUSTRIAL DRIVE ADRIAN, MI 49248 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $76 | — | $76 | 1.74% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DR ADRIAN, MI 49221 | UNUM INSURANCE COMPANY | $491 | $163 | $654 | 20.00% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DE ADRIAN, MI 49221 | UNUM INSURANCE COMPANY | $446 | $148 | $594 | 20.00% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DR ADRIAN, MI 49221 | UNUM INSURANCE COMPANY | $302 | $101 | $403 | 20.05% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DR ADRIAN, MI 49221 | UNUM INSURANCE COMPANY | $278 | $92 | $370 | 19.97% |
| KAPNICK & COMPANY, INC.3 | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | FIRST UNUM LIFE INSURANCE COMPANY | $110 | $37 | $147 | 20.03% |
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 | 115 | 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) | 116 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 239 | $1.3M |
| Dental(2 contracts) | DELTA DENTAL OF MICHIGAN | 136 | $120K |
| Vision | EYEMED VISON CARE | 236 | $14K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 58 | $50K |
| Short-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 58 | $66K |
| Long-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 58 | $66K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 239 | $1.3M |
| Other(8 contracts, 4 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 58 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 239 | — |
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.