| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CORESOURCE, INC.3 Filed as: CORESOURCE | 400 FIELD DR LAKE FOREST, IL 60045 | UNIMERICA INSURANCE COMPANY | $6K | — | $6K | 2.00% |
| HALEY WARD & ASSOCIATES CORP3 Filed as: HALEY AND ASSOCIATES | 970 N VAN DYKE BAD AXE, MI 48413 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 12.44% |
| KAPNICK & COMPANY, INC.3 | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | GUARDIAN | $800 | $847 | $2K | 7.68% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NGS AMERICAN, INC. EIN 38-2259531 | Claims processing Service code 12 | P.O. BOX 2310 MT. CLEMENS, MI 48046 | $85K |
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 | 320 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 320 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNIMERICA INSURANCE COMPANY | 136 | $299K |
| Life insurance | GUARDIAN | 152 | $21K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 140 | $31K |
| Other | GUARDIAN | 152 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 152 | — |
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.