| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DAVID J MCCLELLAN3 Filed as: DAVID GANGI | P.O. BOX 1801 ADRIAN, MI 492217801 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $34K | — | $34K | 3.49% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK INSURANCE & CO., INC. | 333 INDUSTRIAL DRIVE ADRIAN, MI 492218780 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $918 | $918 | 0.09% |
| KAPNICK & COMPANY, INC.3 | 333 INDUSTRIAL DR ADRIAN, MI 49221 | BLUE CARE NETWORK OF MICHIGAN | $2K | — | $2K | 0.45% |
| KAPNICK & COMPANY, INC.3 | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 48108 | DELTA DENTAL OF MICHIGAN | $14K | — | $14K | 9.97% |
| KAPNICK & COMPANY, INC.3 | P.O. BOX 1801 ADRIAN, MI 49221 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $824 | $6K | 12.41% |
| KAPNICK & COMPANY, INC.3 | P.O. BOX 1801 ADRIAN, MI 49221 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $466 | $4K | 15.63% |
| KAPNICK & COMPANY, INC. | PO BOX 1801 ADRIAN, MI 49221 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $317 | — | $317 | 2.15% |
| MICHAEL PANNUTO3 Filed as: MICHAEL P. PANNUTO | 45445 MOUND ROAD, SUITE 102 UTICA, MI 48317 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $86 | — | $86 | 1.27% |
| METRO WORKSITE SERVICES INC.3 | P. O. BOX 39300 REDFORD, MI 48239 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $83 | — | $83 | 1.22% |
| KAPNICK & COMPANY, INC.3 | PO BOX 1801 ADRIAN, MI 49221 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $225 | — | $225 | 3.70% |
| KAPNICK & COMPANY, INC.3 | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | BLUE CARE NETWORK OF MICHIGAN | $20 | — | $20 | 0.44% |
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 | 180 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 184 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 333 | $1.5M |
| Dental | DELTA DENTAL OF MICHIGAN | 370 | $144K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 333 | $970K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 180 | $78K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 16 | $6K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 180 | $46K |
| Prescription drug(3 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 333 | $1.5M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 180 | $60K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 370 | — |
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."
No prospect flags tripped on this filing.