| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK / STEPHEN J. PECK | 769 CHICAGO RD TROY, MI 48083 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $39K | — | $39K | 3.64% |
| KAPNICK & COMPANY, INC.3 | PO BOX 1801 ADRIAN, MI 49221 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $11K | $11K | 1.01% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY, INC. - A. DEAN | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 48108 | DELTA DENTAL PLAN OF MICHIGAN | $18K | $586 | $19K | 3.12% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MI EIN 38-2069753 TPA/CLAIMS ADMINISTRATION | Claims processing; Direct payment from the plan; Consulting (general); Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Insurance services; Other fees Service code 12 | — | $696K |
| KAPNICK AND COMPANY, INC. TPA/CLAIMS ADMINISTRATION | Contract Administrator; Claims processing Service code 12 | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 48108 | $156K |
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 | 784 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 40 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 824 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,938 | $1.1M |
| Dental | DELTA DENTAL PLAN OF MICHIGAN | 1,969 | $600K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,938 | $1.1M |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,938 | $1.1M |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,938 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,969 | — |
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.