| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KAPNICK & COMPANY, INC.3 | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 48108 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $28K | $0 | $28K | 1.78% |
| PATRICK T HORNE3 Filed as: PATRICK REID | 100 NORTH CORPORATE DRIVE SUITE 100 BROOKFIELD, WI 53045 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $15K | $0 | $15K | 0.94% |
| KAPNICK & COMPANY, INC.3 | PO BOX 1801 ADRIAN, MI 49221 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $1K | $1K | 0.09% |
| KAPNICK & COMPANY, INC.3 | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $15K | $3K | $18K | 12.77% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $2K | $2K | 1.48% |
| CENTRO BENEFITS RESEARCH LLC3 | 325 NORTH KIRKWOOD ROAD, SUITE 300 KIRKWOOD, VA 63122 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $1K | $1K | 0.84% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $651 | $0 | $651 | 0.46% |
| KAPNICK & COMPANY, INC.3 | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 48108 | DELTA DENTAL OF MICHIGAN | $9K | $0 | $9K | 6.67% |
| USI INSURANCE SERVICES LLC3 | 100 SUMMIT LAKE DRIVE, SUITE 400 VALHALLA, NY 10595 | DELTA DENTAL OF MICHIGAN | $4K | — | $4K | 3.02% |
| KAPNICK & COMPANY, INC.3 | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | UNUM INSURANCE COMPANY | $1K | $275 | $2K | 7.48% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | UNUM INSURANCE COMPANY | $1K | $204 | $2K | 7.36% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | UNUM INSURANCE COMPANY | $148 | $0 | $148 | 0.67% |
| CENTRO BENEFITS RESEARCH LLC3 | 325 NORTH KIRKWOOD ROAD, SUITE 300 KIRKWOOD, MO 63122 | UNUM INSURANCE COMPANY | $0 | $68 | $68 | 0.31% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 4725 PIEDMONT ROW DRIVE SUITE 510 CHARLOTTE, NC 28210 | UNUM INSURANCE COMPANY | $32 | $8 | $40 | 0.18% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | UNUM INSURANCE COMPANY | $0 | $29 | $29 | 0.13% |
| KAPNICK & COMPANY, INC.3 | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 48108 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $1K | — | $1K | 8.17% |
| TRACY KATZ LLC4 | 1662 EASYT MELTON ROAD BIRMINGHAM, MI 48009 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $348 | — | $348 | 7.96% |
| GALLAGHER BENEFIT SERVICES, INC.4 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2600 SOUTH TELEGRAPH ROAD SUITE 100 BLOOMFIELD HILLS, MI 48302 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $152 | $0 | $152 | 3.48% |
| KAPNICK & COMPANY, INC.4 | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $148 | $0 | $148 | 3.39% |
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 | 117 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 233 | $1.5M |
| Dental | DELTA DENTAL OF MICHIGAN | 244 | $129K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 232 | $13K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 117 | $140K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 117 | $140K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 117 | $140K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 233 | $1.5M |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 117 | $167K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 244 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.