| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NORMAN E. LEWIS3 Filed as: NORMAN E LEWIS | ONE INTERNATIONAL PLAZA SUITE 400 PHILADEPHIA, PA 19153 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $54K | $0 | $54K | 4.49% |
| ACTION BENEFITS COMPANY3 | 25800 NORTHWESTERN HIGHWAY SUITE 600 SOUTHFIELD, MI 48075 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $13K | $0 | $13K | 1.05% |
| USI INSURANCE SERVICES LLC3 | 2600 WEST BIG BEAVER ROAD SUITE 140 TROY, MI 48084 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $1K | $1K | 0.08% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | NEW YORK LIFE GROUP BENEFIT SOLUTIONS | $13K | $0 | $13K | 11.26% |
| USI INSURANCE SERVICES LLC3 | 100 SUMMIT LAKE DRIVE, SUITE 400 VALHALLA, NY 10595 | DELTA DENTAL OF MICHIGAN | $6K | $0 | $6K | 7.57% |
| USI INSURANCE SERVICES LLC3 | 1 HILLCREST DRIVE EAST CHARLESTON, WV 25311 | DELTA DENTAL OF MICHIGAN | $3K | $0 | $3K | 3.04% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO | $1K | $0 | $1K | 9.98% |
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 | 135 | 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) | 135 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 238 | $1.2M |
| Dental | DELTA DENTAL OF MICHIGAN | 253 | $84K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO | 246 | $15K |
| Life insurance | NEW YORK LIFE GROUP BENEFIT SOLUTIONS | 0 | $115K |
| Short-term disability | NEW YORK LIFE GROUP BENEFIT SOLUTIONS | 0 | $115K |
| Long-term disability | NEW YORK LIFE GROUP BENEFIT SOLUTIONS | 0 | $115K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 238 | $1.2M |
| Other | NEW YORK LIFE GROUP BENEFIT SOLUTIONS | 0 | $115K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 253 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.