| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK / STEPHEN J. PECK | PO BOX 1801 ADRIAN, MI 49221 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $22K | $0 | $22K | 2.05% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK / D. HUNTZICKER | PO BOX 1801 ADRIAN, MI 48108 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $16K | $0 | $16K | 1.53% |
| KAPNICK & COMPANY, INC.3 | PO BOX 1801 ADRIAN, MI 49221 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $12K | $12K | 1.15% |
| KAPNICK & COMPANY, INC.3 | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | UNITED OF OMAHA | $38K | $35K | $73K | 7.62% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY, INC. - A. DEAN | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 48108 | DELTA DENTAL PLAN OF MICHIGAN | $20K | $0 | $20K | 2.90% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MI EIN 38-2069753 TPA/CLAIMS ADMINISTRATION | Other fees; Float revenue; Insurance services; Direct payment from the plan; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $854K |
| KAPNICK AND COMPANY, INC. TPA/CLAIMS ADMINISTRATION | Claims processing; Contract Administrator Service code 12 | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 48108 | $202K |
| TELUS HEALTH (US) LTD. EIN 52-1883918 NONE | Other services Service code 49 | 250 ROYALL STREET SUITE 210W CANTON, MA 02021 | $33K |
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 | 979 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 989 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,978 | $1.1M |
| Dental | DELTA DENTAL PLAN OF MICHIGAN | 2,003 | $696K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,978 | $1.1M |
| Life insurance | UNITED OF OMAHA | 1,031 | $956K |
| Short-term disability | UNITED OF OMAHA | 1,031 | $956K |
| Long-term disability | UNITED OF OMAHA | 1,031 | $956K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,978 | $1.1M |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,978 | $1.1M |
| Other | UNITED OF OMAHA | 1,031 | $956K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,003 | — |
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.