| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT V. WEILAND3 | P.O. BOX 1801 ADRIAN, MI 492217801 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $35K | — | $35K | 1.73% |
| ACTION BENEFITS COMPANY3 | 24600 NORTHWESTERN SOUTHFIELD, MI 48075 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $13K | — | $13K | 0.62% |
| KAPNICK & COMPANY, INC.3 | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 481081690 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $2K | $2K | 0.10% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC. | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $22K | $4K | $26K | 17.71% |
| KAPNICK & COMPANY, INC.3 | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 48108 | DELTA DENTAL OF MICHIGAN | $6K | — | $6K | 4.32% |
| KAPNICK & COMPANY, INC.3 | 333 INDUSTRIAL DRIVE P.O. BOX 1801 ADRIAN, MI 49221 | NATIONAL VISION ADMINISTRATORS, LLC | $2K | — | $2K | 10.00% |
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 | 170 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 173 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 361 | $2.0M |
| Dental | DELTA DENTAL OF MICHIGAN | 375 | $135K |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 371 | $16K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 169 | $146K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 169 | $146K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 361 | $2.0M |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 169 | $146K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 375 | — |
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.