| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DEVON J DOBRIN3 | 901 WILSHIRE DRIVE SUITE 330 TROY, MA 48084 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $30K | — | $30K | 1.59% |
| WILSHIRE BENEFITS GROUP INC3 | 901 WILSHIRE DRIVE SUITE 300 TROY, MI 48084 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $1K | $1K | 0.06% |
| WILSHIRE BENEFITS GROUP INC3 Filed as: WILSHIRE BENEFITS GROUP, INC | 901 WILSHIRE DRIVE SUITE 300 TROY, MI 48084 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $3K | $12K | 2.48% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 808 GLENDALOUGH ROAD ERDENHEIM, PA 19038 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | 0.82% |
| DEVON J DOBRIN3 | 901 WILSHIRE DRIVE SUITE 330 TROY, MI 48084 | BLUE CARE NETWORK OF MICHIGAN | $8K | — | $8K | 1.86% |
| WILSHIRE BENEFITS GROUP INC3 | 901 WILSHIRE DRIVE SUITE 300 TROY, MI 48084 | BLUE CARE NETWORK OF MICHIGAN | — | $457 | $457 | 0.11% |
| WILSHIRE BENEFITS GROUP INC3 Filed as: WILSHIRE BENEFITS GROUP, INC | 901 WILSHIRE DRIVE SUITE 300 TROY, MI 48084 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $2K | $10K | 13.11% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 808 GLENDALOUGH ROAD ERDENHEIM, PA 19038 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 1.49% |
| WILSHIRE BENEFITS GROUP INC3 | 901 WILSHIRE DRIVE TROY, MI 48084 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5K | — | $5K | 8.28% |
| THOMAS DANIEL SCHMIDT3 | 21608 PINE CONE DRIVE MACOMB, MI 48042 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 2.81% |
| CYNTHIA SUSANNE EVERY3 | 212 WEST DUNCAN MANCHESTER, MI 48158 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $75 | $1K | 2.56% |
| DIANNA LYNN ATCHISON3 | 225 EAST DIVISION ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $36 | $1K | 2.54% |
| JEREMY SAMPSEL3 | 3030 SOUTH 9TH STREET KALAMAZOO, MI 49009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $251 | $425 | $676 | 1.24% |
| EVETTE SUSAN KENDZIERSKI3 | 22596 CLEARWATER DRIVE MACOMB, MI 48044 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $225 | $27 | $252 | 0.46% |
| BALLARD FINANCIAL LLC3 | 17441 MADISON STREET SOUTHFIELD, MI 48076 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $204 | — | $204 | 0.37% |
| W F HILL AND ASSOCIATES INC3 | 30700 TELEGRAPH ROAD BINGHAM FARMS, MI 48025 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $104 | $28 | $132 | 0.24% |
| DENA ANN MARTHA3 | 225 EAST DIVISION STREET ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | — | $23 | 0.04% |
| HOWARD HOROWITZ3 Filed as: HOWARD J HOROWITZ | 2610 ALCOTT STREET CARMEL, IN 46032 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | — | $20 | 0.04% |
| DAVID N SOKOL3 Filed as: DAVID NEIL SOKOL | 901 WILSHIRE DRIVE SUITE 300 TROY, MI 48084 | NORTHWESTERN MUTUAL | $2K | $466 | $2K | 5.07% |
| IVAN MATTHEW PERUSKI3 | 5444 STATE STREET SAGINAW, MI 48603 | NORTHWESTERN MUTUAL | $925 | $233 | $1K | 2.53% |
| MARK E HARDY3 | 5444 STATE STREET SAGINAW, MI 48603 | NORTHWESTERN MUTUAL | $925 | $233 | $1K | 2.53% |
| DOMINIC ANTHONY MIRABELLA3 Filed as: DOMINIC MIRABELLA | 901 WILSHIRE DRIVE SUITE 300 TROY, MI 48084 | NORTHWESTERN MUTUAL | $661 | $79 | $740 | 1.62% |
| GARY J MESSING3 | 114 EAST BROADWAY STREET MT PLEASANT, MI 48858 | NORTHWESTERN MUTUAL | $308 | $111 | $419 | 0.92% |
| DOMINIC ANTHONY MIRABELLA3 | 901 WILSHIRE DRIVE SUITE 300 TROY, MI 48084 | NORTHWESTERN MUTUAL | $24 | $3 | $27 | 0.06% |
| WILSHIRE BENEFITS GROUP INC3 Filed as: WILSHIRE BENEFITS GROUP, INC. | 901 WILSHIRE DRIVE #330 TROY, MI 48084 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $3K | — | $3K | 9.95% |
| WILSHIRE BENEFITS GROUP INC3 Filed as: WILSHIRE BENEFITS GROUP, INC | 901 WILSHIRE DRIVE SUITE 300 TROY, MI 48084 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $808 | $4K | 14.28% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 808 GLENDALOUGH ROAD ERDENHEIM, PA 19038 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $462 | $462 | 1.53% |
| WILSHIRE BENEFITS GROUP INC3 Filed as: WILSHIRE BENEFITS GROUP, INC | 901 WILSHIRE DRIVE SUITE 300 TROY, MI 48084 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $539 | $3K | 12.72% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 808 GLENDALOUGH ROAD ERDENHEIM, PA 19038 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $308 | $308 | 1.55% |
| UNITED OF OMAHA LIFE INSURANCE CO3 | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $13K | $13K | — |
| WILSHIRE BENEFITS GROUP INC3 Filed as: WILSHIRE BENEFITS GROUP, INC | 901 WILSHIRE DRIVE SUITE 300 TROY, MI 48084 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $356 | $356 | — |
| PATRIOT GROWTH INSURANCE SERVICES3 | 808 GLENDALOUGH ROAD ERDENHEIM, PA 19038 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $203 | $203 | — |
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 | 270 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 276 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 368 | $2.3M |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 243 | $469K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 635 | $31K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 266 | $93K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 266 | $0 |
| Long-term disability(2 contracts, 2 carriers) | NORTHWESTERN MUTUAL | 64 | $76K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 266 | $148K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 635 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.