| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MICHAEL BUCK3 | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $20K | — | $20K | 3.50% |
| SALUS GROUP3 | — | HARTFORD LIFE AND ACCIDENT | $3K | $0 | $3K | 13.19% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 NONE | Claims processing; Direct payment from the plan; Contract Administrator; Float revenue; Consulting (general); Insurance services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees Service code 12 | — | $413K |
| TIC INTERNATIONAL CORP. EIN 13-2600875 NONE | Contract Administrator; Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $94K |
| JEFFEY M LESSER NONE | Legal; Direct payment from the plan Service code 29 | 39040 SEVEN MILE ROAD LIVONIA, MI 481521006 | $82K |
| THE SALUS GROUP EIN 20-2024076 NONE | Insurance agents and brokers; Non-monetary compensation; Other commissions; Insurance brokerage commissions and fees Service code 22 | — | $38K |
| DELTA DENTAL EIN 38-1791480 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Insurance services; Float revenue; Claims processing; Consulting (general); Contract Administrator; Other fees; Direct payment from the plan Service code 12 | — | $27K |
| COMERICA BANK EIN 38-0477375 NONE | Direct payment from the plan; Custodial (securities) Service code 19 | — | $17K |
| ERMIN, TEICHER EIN 38-1468534 NONE | Legal; Direct payment from the plan Service code 29 | — | $11K |
| UAS NONE | Direct payment from the plan; Actuarial Service code 11 | 11590 NORTH MERIDAN SUITE #610 CARMEL, IN 460324529 | $10K |
| WRUBEL WESLEY AND COMPANY C.P.A.'S EIN 38-2574238 NONE | Direct payment from the plan; Accounting (including auditing) 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 | 508 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 78 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 586 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE AND ACCIDENT | 570 | $23K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 586 | $571K |
| Other | HARTFORD LIFE AND ACCIDENT | 570 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 586 | — |
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.