| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MICHIGAN, INC | 26555 EVERGREEN RD STE 1600 SOUTHFIELD, MI 48076 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $17K | $0 | $17K | 1.97% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF DETROIT INC | 35735 MOUND RD PO BOX 8029 STERLING HEIGHTS, MI 48311 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 0.39% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $224 | $224 | 0.03% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF DETROIT INC | 35735 MOUND RD STERLING HEIGHTS, MI 48310 | DELTA DENTAL OF MICHIGAN | $7K | $0 | $7K | 1.36% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF DETROIT INC | 35735 MOUND RD STERLING HEIGHTS, MI 48310 | VISION SERVICE PROVIDER | $3K | $0 | $3K | 2.59% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MICHIGAN, INC | PO BOX 416719 BOSTON, MA 02241 | VISION SERVICE PROVIDER | $2K | $0 | $2K | 1.98% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF DETROIT INC | PO BOX 8029 STERLING HEIGHTS, MI 48311 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $8K | $2K | $10K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Claims processing; Direct payment from the plan; Contract Administrator; Float revenue; Consulting (general); Insurance services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees Service code 12 | — | $444K |
| DELTA DENTAL OF MICHIGAN EIN 38-1791480 TPA | Contract Administrator; Claims processing Service code 12 | — | $40K |
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 | 635 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 109 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 744 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 581 | $0 |
| Dental | DELTA DENTAL OF MICHIGAN | 1,305 | $498K |
| Vision | VISION SERVICE PROVIDER | 48 | $100K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 635 | $886K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 635 | $886K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 581 | $0 |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 635 | $886K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,305 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.