| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MICHAEL BUCK3 | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $19K | — | $19K | 3.49% |
| ASSOCIATION BENEFITS CO3 | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $990 | — | $990 | 0.18% |
| ASSOCIATION BENEFITS CO3 Filed as: ASSOCIATION BENEFITS COMPANY | 26555 EVERGREEN ROAD SUITE 410 SOUTHFIELD, MI 48076 | HARTFORD LIFE INSURANCE | $3K | — | $3K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 NONE | Insurance services; Consulting (general); Contract Administrator; Direct payment from the plan; Claims processing; Non-monetary compensation; Other fees; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $402K |
| TIC INTERNATIONAL CORP. EIN 13-2600875 NONE | Contract Administrator; Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $94K |
| JEFFREY M. LESSER EIN 38-3033865 NONE | Legal; Direct payment from the plan Service code 29 | — | $62K |
| ASSOCIATION BENEFITS CO. NONE | Insurance brokerage commissions and fees; Non-monetary compensation; Insurance agents and brokers; Other commissions Service code 22 | 27333 MEADOWBROOK # S-230 NOVI, MI 48377 | $38K |
| DELTA DENTAL EIN 38-1791480 NONE | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general); Insurance services; Float revenue; Claims processing; Direct payment from the plan; Other fees Service code 12 | — | $30K |
| COMERICA BANK EIN 38-0477375 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $16K |
| UAS NONE | Actuarial; Direct payment from the plan Service code 11 | 11590 NORTH MERIDAN SUITE #610 CARMEL, IN 460324529 | $10K |
| WRUBEL WESLEY AND COMPANY C.P.A.'S EIN 38-2574238 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $9K |
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 | 469 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 103 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 572 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,050 | $549K |
| Other | HARTFORD LIFE INSURANCE | 574 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,050 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.