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| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Contract Administrator; Direct payment from the plan; Insurance services; Float revenue; Consulting (general); Claims processing; Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $308K |
| RONALD R SCHOEN INSURANCE AGENT | Other commissions; Other fees; Insurance agents and brokers; Non-monetary compensation; Insurance brokerage commissions and fees Service code 22 | 6628 DIXIE HWY BRIDGEPORT, MI 487229623 | $30K |
| EMPLOYEE BENEFIT RESOURCES INSURANCE AGENT | Other fees; Other commissions; Insurance brokerage commissions and fees; Non-monetary compensation; Insurance agents and brokers Service code 22 | 6628 DIXIE HWY BRIDGEPORT, MI 487229623 | $24K |
| KEYSTONE INSURERS GROUP INC INSURANCE AGENT | Other fees; Non-monetary compensation; Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions Service code 22 | 1995 POINT TOWNSHIP DR NORTHUMBERLAN, PA 178578856 | $8K |
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 | 384 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 384 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 699 | $357K |
| Dental | BLUE CROSS BLUE SHIELD OF MICHIGAN | 699 | $357K |
| Vision | VISION SERVICE PLAN | 266 | $77K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 387 | $96K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 387 | $96K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 699 | $357K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 699 | $357K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 387 | $96K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 699 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.