| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROSE STREET ADVISORS LLC3 | 244 N ROSE ST KALAMAZOO, MI 49007 | SUN LIFE ASSURANCE COMPANY OF CANADA | $7K | — | $7K | 6.70% |
| M FINANCIAL HOLDINGS INC3 Filed as: M FINANCIAL HOLDINGS, INC | 1125 NW COUCH ST STE 900 PORTLAND, OR 97209 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $1K | $1K | 1.04% |
| GREGORY A. HAGBOM3 Filed as: GREGORY C THOMPSON | 3448 WENDOVER RD TROY, MI 48084 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5K | $26 | $6K | 8.98% |
| MICHELLE LIVINGSTON3 | 18211 DORSET ST SOUTHFIELD, MI 48075 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $570 | — | $570 | 0.93% |
| KENNETH JAMES BOWERY3 | 25471 PENNSYLVANIA AVE NOVI, MI 48375 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $223 | $105 | $328 | 0.53% |
| RAY SCOTT3 | 5318 INDIAN TRAIL YPSILANTI, MI 48197 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $94 | — | $94 | 0.15% |
| LACROSS GROUP INC3 | 44062 RINA LANE CLINTON TWP, MI 48038 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.02% |
| DONALD F GAY3 | 18701 GRAND RIVER DETROIT, MI 48223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.01% |
| JAMES A SMAARDYK3 Filed as: JAMES M TAYLOR | 3016 SPRING HILL PKWY SE SMYRNA, GA 30080 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.01% |
| W F HILL AND ASSOCIATES INC3 | 600 WEST LAFAYETTE DETROIT, MI 48226 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.01% |
| ADVANTAGE BENEFITS GROUP3 Filed as: ADVANTAGE BENEFITS GROUP INC | 89 MONROE CENTER GRAND RAPIDS, MI 49503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.01% |
| MARY LOU TAYLOR3 | 3016 SPRING HILL PKWY SE SMYRNA, GA 30080 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Insurance services; Consulting (general); Claims processing; Float revenue; Other fees Service code 12 | — | $156K |
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 | 310 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 310 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 310 | $160K |
| Short-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 310 | $160K |
| Long-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 310 | $160K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 310 | $98K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 310 | — |
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.