| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | PO BOX 416719 BOSTON, MA 022416719 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $73K | $0 | $73K | 11.61% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF CA INC | C/O WILLIS SAN FRANCISCO LOCKBOX LOCKBOX 100485 BANC ONE DEPT 100485 PASADENA, CA 911890485 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $13K | $0 | $13K | 2.10% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $132 | $132 | 0.02% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $22 | $22 | 0.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC | RAYMOND DEWEY 330 W COLLEGE AVE APPLETON, WI 54911 | DELTA DENTAL OF MICHIGAN | $5K | $0 | $5K | 1.12% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MICHIGAN, INC | RAYMOND DEWEY PO BOX 416719 BOSTON, MA 022416719 | DELTA DENTAL OF MICHIGAN | $3K | $599 | $3K | 0.68% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MICHIGAN, INC | 333 BRIDGE STREET NW STE 710 GRAND RAPIDS, MI 495045356 | VISION SERVICE PROVIDER | $2K | $0 | $2K | 1.61% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC | 333 BRIDGE ST NW STE 710 GRAND RAPIDS, MI 495045356 | VISION SERVICE PROVIDER | $927 | $0 | $927 | 0.72% |
| RAYMOND D DEWEY3 | 333 BRIDGE ST NW STE 710 GRAND RAPIDS, MI 495045356 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $14K | $88K | $102K | — |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MICHIGAN (GR RAPIDS) | 333 BRIDGE ST NW STE 710 GRAND RAPIDS, MI 495045356 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $5K | $5K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Float revenue; Consulting (general); Claims processing; Insurance brokerage commissions and fees; Non-monetary compensation; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Other commissions; Contract Administrator; Insurance services; Insurance agents and brokers; Other fees Service code 12 | — | $699K |
| DELTA DENTAL OF MICHIGAN EIN 38-1791480 BENEFITS ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $44K |
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 | 737 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 120 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 857 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,450 | $0 |
| Dental | DELTA DENTAL OF MICHIGAN | 1,446 | $471K |
| Vision | VISION SERVICE PROVIDER | 601 | $128K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 737 | $630K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 737 | $630K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,450 | $0 |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 737 | $630K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,450 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.