| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAMBRIDGE CONSULTING GROUP LLC3 | 101 W BIG BEAVER SUITE 600 TROY, MI 480845282 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | — | $0 | 0.00% |
| SAGINAW BAY UNDERWRITERS3 Filed as: SAGINAW UNDERWRITERS INC | PO BOX 1928 SAGINAW, MI 48605 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $6K | — | $6K | 3.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 NONE | Contract Administrator; Claims processing; Other fees; Direct payment from the plan; Float revenue; Insurance services; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $532K |
| BENESYS, INC. EIN 38-2383171 RECORDKEEPER | Plan Administrator; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 14 | 700 TOWER DRIVE, STE 300 TROY, MI 48098 | $117K |
| NOVARA TESIJA, P.L.L.C. NONE | Legal; Direct payment from the plan Service code 29 | 2000 TOWN CTR STE 2370 248-354-0380 SOUTHFIELD, MI 48075 | $100K |
| TFBC, LLC EIN 27-3782504 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $70K |
| UNION SERVICE AGENCY NONE | Direct payment from the plan; Insurance services Service code 23 | 119 PERE MARQUETTE STE 1A 517-482-6700 LANSING, MI 48912 | $15K |
| PLUMBERS & PIPEFITTERS UA LOCAL 85 EIN 38-1119237 CONTRIBUTING EMPLOYER | Direct payment from the plan; Copying and duplicating; Other services Service code 36 | — | $14K |
| AMERICAN GRAPHICS PRINTING CO EIN 38-2090931 NONE | Copying and duplicating; Direct payment from the plan Service code 36 | — | $13K |
| BULTYNCK & CO., P.L.L.C EIN 20-3920878 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | 15985 CANAL ROAD CLINTON TOWNSHIP, MI 48038 | $12K |
| EVOLUTION 1, INC. NONE | Claims processing; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 4324 20TH AVE SW STE 200 877-221-4541 FARGO, ND 58103 | $9K |
| VARNUM, LLP NONE | Legal; Direct payment from the plan Service code 29 | 160 W FORT ST FL 5 313-481-7300 DETROIT, MI 48226 | $7K |
| UNITED ACTUARIAL SERVICES EIN 13-2600875 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $7K |
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 | 640 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 302 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 942 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 430 | $1.9M |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,195 | $210K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,195 | $210K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,195 | $210K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 430 | $1.9M |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 942 | $466K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,195 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.