| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RAYMOND S. LUNDSTEN3 | 1 INTERNATIONAL PLAZA, SUITE 40 PHILADELPHIA, PA 19113 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $50K | $0 | $50K | 1.33% |
| USI INSURANCE SERVICES LLC3 | 100 SUMMIT LAKE DRIVE, SUITE 40 VALHALLA, NY 10595 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $1K | $1K | 0.03% |
| USI INSURANCE SERVICES LLC3 | 1 HILLCREST DRIVE EAST CHARLESTON, WV 25311 | DELTA DENTAL OF MICHIGAN | $10K | $0 | $10K | 4.76% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $17K | $6K | $23K | 20.29% |
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 | 199 | 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) | 199 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 436 | $3.8M |
| Dental | DELTA DENTAL OF MICHIGAN | 547 | $201K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 306 | $116K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 306 | $116K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 436 | $3.8M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 306 | $116K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 547 | — |
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.