| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EARL JEFFREY SAMS3 | PO BOX 1748 SAGINAW, MI 486051748 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $14K | $20K | $34K | 1.98% |
| SAGINAW BAY UNDERWRITERS3 | 1258 S WASHINGTON SAGINAW, MI 486012509 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $3K | $3K | 0.18% |
| SAGINAW BAY UNDERWRITERS3 Filed as: SAGINAW BAY UNDERWRITERS INC | PO BOX 1928 SAGINAW, MI 48605 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 6.29% |
| SAGINAW BAY UNDERWRITERS3 Filed as: SAGINAW UNDERWRITERS, INC. | PO BOX 1928 SAGINAW, MI 48605 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 8.74% |
No Schedule C service providers reported on this filing.
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 | 160 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 160 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 150 | $1.7M |
| Life insurance | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 160 | $27K |
| Other(2 contracts) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 160 | $72K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 160 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
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.