| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KATHERINE C WOOD3 Filed as: KATHERINE C. WOOD | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 481081690 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $39K | — | $39K | 2.50% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK INSURANCE & CO., INC. | 333 INDUSTRIAL DRIVE P. O. BOX 1801 ADRIAN, MI 492218780 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $2K | — | $2K | 0.13% |
| KAPNICK & COMPANY, INC.3 | 333 INDUSTRIAL DRIVE PO BOX 1801 ADRIAN, MI 49221 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 3.47% |
| KAPNICK & COMPANY, INC.3 | P.O. BOX 1801 ADRIAN, MI 49221 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $601 | $6K | 20.00% |
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 | 367 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 368 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 322 | $1.6M |
| Dental | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 240 | $97K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 367 | $30K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 322 | $1.6M |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 367 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 367 | — |
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.