| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DRIVE, PO BOX 1801 ADRIAN, MI 49221 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $3K | $10K | 7.52% |
| ASSUREX3 | 175 SOUTH 3RD ST, SUITE 800 COLUMBUS, OH 43215 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| KAPNICK & COMPANY, INC.3 | 1201 BRIARWOOD CIR ANN ARBOR, MI 48108 | DELTA DENTAL OF MICHIGAN | $2K | — | $2K | 3.23% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DRIVE, P.O. BOX 1801 ADRIAN, MI 492217801 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1K | $173 | $1K | 16.99% |
| KAPNICK & COMPANY, INC.4 Filed as: KAPNICK & COMPANY INC. | 769 CHICAGO RD 3RD FLOOR TROY, MI 48083 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $230 | — | $230 | 14.36% |
| KELLY HARNESS3 | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $10K | $28K | $37K | — |
| ANGELA M DEAN3 | PO BOX 1801 ADRIAN, MI 49221 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $2K | — | $2K | — |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK AND COMPANY INC. | PO BOX 1801 ADRIAN, MI 49221 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $1K | $1K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Contract Administrator; Direct payment from the plan; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Float revenue; Insurance services; Consulting (general) Service code 12 | — | $381K |
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 | 134 | 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) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF MICHIGAN | 225 | $57K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 128 | $129K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 128 | $129K |
| Long-term disability | THE PAUL REVERE LIFE INSURANCE COMPANY | 38 | $9K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 190 | $0 |
| Other | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | 13 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 225 | — |
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.