| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KAPNICK & COMPANY, INC.3 | P.O. BOX 1801 ADRIAN, MI 49221 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $1K | $10K | 15.41% |
| KAPNICK & COMPANY, INC.3 | P.O. BOX 1801 ADRIAN, MI 49221 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $383 | $4K | 15.38% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Other fees; Float revenue; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Insurance services; Contract Administrator; Claims processing Service code 12 | — | $198K |
| DEBRA A. YOUNGS INSURANCE AGENT | Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers; Non-monetary compensation Service code 22 | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 481081690 | $0 |
| KAPNICK INSURANCE & CO., INC. INSURANCE AGENT | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions; Non-monetary compensation Service code 22 | 333 INDUSTRIAL DRIVE ADRIAN, MI 492210870 | $0 |
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 | 321 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 41 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 362 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 314 | $89K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 314 | $66K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 314 | $89K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 314 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.