| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 318 E CARRUTH LANE DOUBLE OAK, TX 75077 | HARTFORD LIFE AND ACCIDENT | $53K | $52K | $106K | 6.97% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 950080667 | KAISER FOUNDATION HEALTH PLAN INC | $58K | — | $58K | 4.63% |
| COWDEN ASSOCIATES INC3 | 444 LIBERTY AVENUE STE 1900 PITTSBURGH, PA 15222 | BLUE CROSS & BLUE SHIELD OF MICHIGAN | — | $78K | $78K | 8.04% |
| ELLIOT N DINKIN3 | 444 LIBERTY AVENUE STE 1900 PITTSBURGH, PA 15222 | BLUE CROSS & BLUE SHIELD OF MICHIGAN | $36K | — | $36K | 3.69% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 950080667 | KAISER FOUNDATION HEALTH PLAN INC | $9K | — | $9K | 4.59% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MUSGROVE ASSOCIATES NONE | Contract Administrator; Direct payment from the plan Service code 13 | P.O. BOX 1769 SALEM, VA 24153 | $2.5M |
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 NONE | Insurance services; Other fees; Claims processing; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general); Float revenue; Contract Administrator Service code 12 | — | $1.8M |
| BDO USA, P.C. EIN 13-5381590 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $534K |
| ACRISURE MID-ATLANTIC PARTNERS INS. EIN 26-3554645 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $179K |
| COWDEN ASSOCIATES, INC. EIN 25-1750131 NONE | Consulting (general); Direct payment from the plan; Insurance agents and brokers Service code 16 | — | $66K |
| GREGORY, MOORE, BROOKS, CLARK EIN 38-3093929 NONE | Legal; Direct payment from the plan Service code 29 | — | $59K |
| SPFPA INTERNATIONAL UNION EIN 38-1294556 NONE | Other services; Direct payment from the plan Service code 49 | — | $25K |
| VARNUM EIN 38-1294924 NONE | Legal; Direct payment from the plan Service code 29 | — | $23K |
| MOONEY, GREEN, SAINDON, MURPHY NONE | Legal; Direct payment from the plan Service code 29 | 1620 EYE ST. NW STE. 700 WASHINGTON, DC 20006 | $12K |
| WESTERN INTERNATIONAL SECURITIES EIN 84-1314321 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $9K |
| WELLS FARGO BANK, N.A. NONE | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | CAPITAL RBCO 1753 PINNACLE DR - MAC R3076-03E MCLEAN, VA 22102 | $7K |
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 | 3,490 | 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) | 3,490 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS & BLUE SHIELD OF MICHIGAN | 5,010 | $968K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 1,101 | $1.5M |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 1,101 | $1.5M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 1,101 | $1.5M |
| Prescription drug | BLUE CROSS & BLUE SHIELD OF MICHIGAN | 5,010 | $968K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS & BLUE SHIELD OF MICHIGAN | 5,010 | $968K |
| Other | HARTFORD LIFE AND ACCIDENT | 1,101 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,010 | — |
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.