| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KATHLEEN C WOOD3 | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 481081690 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $59K | — | $59K | 3.03% |
| KAPNICK & COMPANY, INC.3 | PO BOX 1801 ADRIAN, MI 492219221 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $2K | $2K | 0.10% |
| KAPNICK & COMPANY, INC.3 | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 48108 | DELTA DENTAL OF MICHIGAN | $7K | — | $7K | 4.70% |
| KAPNICK & COMPANY, INC.3 | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $2K | $9K | 19.77% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $2K | $9K | 19.92% |
| KAPNICK & COMPANY, INC.3 | 333 INDUSTRIAL DR ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $2K | $8K | 19.69% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK AND COMPANY, INC. | 333 INDUSTRIAL DR ADRIAN, MI 492218780 | EYEMED VISION CARE | $1K | — | $1K | 9.13% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK INSURANCE GROUP | 333 INDUSTRIAL DR ADRIAN, MI 49221 | CONTINENTAL AMERICAN INSURANCE COMPANY | $612 | — | $612 | 8.36% |
| THOMAS W BOSTON3 Filed as: THOMAS A. DANKO | 71550 ELDRED RD BRUCE TWP, MI 48065 | CONTINENTAL AMERICAN INSURANCE COMPANY | $43 | — | $43 | 0.59% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK INSURANCE GROUP | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 48108 | ZURICH AMERICAN INSURANCE COMPANY | $179 | — | $179 | 15.04% |
| UNITED OF OMAHA LIFE INSURANCE CO5 | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | — |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $201 | $201 | — |
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 | 208 | 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. |
| Total participants (= "Plan participants" tile) | 209 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 293 | $2.0M |
| Dental | DELTA DENTAL OF MICHIGAN | 321 | $143K |
| Vision | EYEMED VISION CARE | 246 | $16K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 208 | $87K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 202 | $0 |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 202 | $48K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 293 | $1.9M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 208 | $43K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 321 | — |
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.