| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DOUGLAS TRUAX3 | 1900 SPRING ROAD, SUITE 530 OAK BROOK, IL 60523 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $39K | $0 | $39K | 1.96% |
| DOUGLAS TRUAX3 | 1900 SPRING ROAD SUITE 530 OAK BROOK, IL 60523 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $39K | $0 | $39K | 4.58% |
| VERITAS RISK SERVICES3 Filed as: VERITAS RISK SERVICES, LLC | 1900 SPRING ROAD, SUITE 530 OAK BROOK, IL 60523 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $55K | $0 | $55K | 6.51% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $61 | $61 | 0.01% |
| NATIONAL BENEFIT CONSULTANTS, INC.3 | 208 E OAK CREST DRIVE WALES, WI 53183 | TRANSAMERICA PREMIER LIFE INSURANCE CO. | $27K | $0 | $27K | 12.00% |
| NATIONAL BENEFITS CONSULTANTS, INC.3 | 208 E OAK CREST DRIVE WALES, WI 53183 | EXPRESS SCRIPTS, INC | $4K | $0 | $4K | 2.34% |
| VERITAS RISK SERVICES3 Filed as: VERITAS RISK SERVICES, LLC | 1900 SPRING ROAD, SUITE 530 OAK BROOK, IL 60523 | DELTA DENTAL OF MICHIGAN | $8K | $0 | $8K | 5.06% |
| VERITAS RISK SERVICES3 Filed as: VERITAS RISK SERVICES, LLC | 1900 SPRING ROAD, SUITE 530 OAK BROOK, IL 60523 | EYEMED VISION CARE | $4K | $0 | $4K | 12.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TOWERS WATSON INVESTMENT SVC INC EIN 52-1868818 NONE | Investment management fees paid directly by plan; Direct payment from the plan; Securities brokerage; Investment management Service code 28 | — | $71K |
| STATE STREET BANK AND TRUST EIN 04-1867445 NONE | Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $55K |
| TOWERS WATSON DELAWARE INC. EIN 53-0181291 NONE | Investment management; Securities brokerage; Investment management fees paid directly by plan Service code 28 | — | $12K |
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 | 150 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 339 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 489 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 500 | $3.1M |
| Dental | DELTA DENTAL OF MICHIGAN | 456 | $152K |
| Vision | EYEMED VISION CARE | 510 | $30K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 373 | $841K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 373 | $841K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 373 | $841K |
| Prescription drug(3 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 500 | $3.0M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 373 | $845K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 510 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.