| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFITS SOLUTIONS GROUP LLC3 | 2400 WOLF RD STE 100 WESTCHESTER, IL 60154 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $33K | — | $33K | 3.38% |
| BROGAN INSURANCE3 | 320 W LAKE LANSING ROAD EAST LANSING, MI 488238823 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $11K | — | $11K | 1.18% |
| BENEFITS SOLUTIONS GROUP LLC3 | 2400 WOLF RD STE 100 WESTCHESTER, IL 60154 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $472 | — | $472 | 0.08% |
| BENEFITS SOLUTIONS GROUP LLC3 | 2400 WOLF RD STE 100 WESTCHESTER, IL 60154 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $159 | — | $159 | 0.07% |
| BENEFITS SOLUTIONS GROUP LLC3 Filed as: BENEFITS SOLUTIONS GROUP | 2400 WOLF RD STE 100 WESTCHESTER, IL 60154 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $22K | — | $22K | 15.00% |
| LOTTES, DOUGLAS E3 | 1036 CAMDEN DR LANSING, MI 48917 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | — | $5K | 3.64% |
| TITAN BENEFIT COMMUNICATIONS LLC3 | 504 EAST 4TH ST ROYAL OAK, MI 48067 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 0.79% |
| PIERCE, DWIGHT, L3 Filed as: PIERCE, DWIGHT - BENEFITS TECHNOLOG | 1200 E. TAFT AVENUE SAPULPA, OK 74066 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $104 | — | $104 | 0.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNUM LIFE INSURANCE CO OF AMERICA EIN 01-0278678 N/A | Contract Administrator Service code 13 | — | $33K |
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 | 1,299 | 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) | 1,299 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUE CROSS BLUE SHIELD OF MICHIGAN | 3,074 | $965K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 3,074 | $965K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 652 | $143K |
| Long-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,326 | $828K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,326 | $742K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,074 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.