| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EARL JEFFREY SAMS3 | PO BOX 1748 SAGINAW, MI 486051748 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $10K | $27K | $36K | 1.62% |
| SAGINAW BAY UNDERWRITERS3 | 1258 S WASHINGTON SAGINAW, MI 486012509 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $2K | $2K | 0.09% |
| SAGINAW BAY UNDERWRITERS3 Filed as: SAGINAW UNDERWRITERS INC | PO BOX 1928 SAGINAW, MI 48605 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 5.43% |
| SAGINAW BAY UNDERWRITERS3 Filed as: SAGINAW UNDERWRITERS, INC. | PO BOX 1928 SAGINAW, MI 48605 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 8.33% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Contract Administrator; Float revenue; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Other fees; Insurance services; Consulting (general) Service code 12 | — | $136K |
| EARL J SAMS AGENT | Non-monetary compensation; Other fees; Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | PO BOX 1748 SAGINAW, MI 486051748 | $36K |
| SAGINAW BAY UNDERWRITERS AGENT | Other fees; Insurance brokerage commissions and fees; Other commissions; Insurance agents and brokers; Non-monetary compensation Service code 22 | 1258 S WASHINGTON SAGINAW, MI 486012509 | $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 | 177 | 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. |
| Total participants (= "Plan participants" tile) | 177 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 166 | $2.3M |
| Life insurance | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 177 | $30K |
| Other(2 contracts) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 177 | $85K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 177 | — |
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.