| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 GOLF ROAD FL 4 ROLLING MEADOWS, IL 60008 | DELTA DENTAL OF MICHIGAN | $15K | — | $15K | 9.85% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | 30150 TELEGRAPH RD, STE 408 BINGHAM FARMS, MI 480254520 | LIFE INSURANCE COMPANY OF NORTH AMERICA - LT DISABILITY | $5K | — | $5K | 17.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | 30150 TELEGRAPH RD, STE 408 BINGHAM FARMS, MI 480254520 | LIFE INSURANCE COMPANY OF NORTH AMERICA - LT DISABILITY | — | $422 | $422 | 1.42% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | 2850 GOLF ROAD FL 4 ROLLING MEADOWS, IL 60008 | NATIONAL VISION ADMINISTRATORS, LLC | $2K | — | $2K | 8.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | 30150 TELEGRAPH RD, STE 408 BINGHAM FARMS, MI 480254520 | LIFE INSURANCE COMPANY OF NORTH AMERICA - GROUP LIFE | $4K | — | $4K | 17.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | 30150 TELEGRAPH RD, STE 408 BINGHAM FARMS, MI 480254520 | LIFE INSURANCE COMPANY OF NORTH AMERICA - GROUP LIFE | — | $309 | $309 | 1.42% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 2850 GOLF ROAD FL 4 ROLLING MEADOWS, IL 60008 | DELTA DENTAL OF MICHIGAN | $939 | — | $939 | 7.72% |
| LAU & LAU ASSOCIATES LLC3 Filed as: LAU & LAU ASSOCIATES | 41000 WOODWARD AVE STE 250 E BLOOMFIELD HILLS, MI 48304 | UNUM LIFE - LONG TERM CARE | $2K | — | $2K | 20.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | 30150 TELEGRAPH RD, STE 408 BINGHAM FARMS, MI 480254520 | LIFE INSURANCE COMPANY OF NORTH AMERICA - ST DISABILITY | $2K | — | $2K | 17.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | 30150 TELEGRAPH RD, STE 408 BINGHAM FARMS, MI 480254520 | LIFE INSURANCE COMPANY OF NORTH AMERICA - ST DISABILITY | — | $166 | $166 | 1.40% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 30150 TELEGRAPH RD, STE 408 BINGHAM FARMS, MI 480255708 | LIFE INSURANCE COMPANY OF NORTH AMERICA - ACCIDENTAL DEATH | $386 | — | $386 | 17.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 30150 TELEGRAPH RD, STE 408 BINGHAM FARMS, MI 480255708 | LIFE INSURANCE COMPANY OF NORTH AMERICA - ACCIDENTAL DEATH | — | $32 | $32 | 1.41% |
| KELLEY A. DEMIRYAN3 | 30150 TELEGRAPH RD, STE 408 BINGHAM FARMS, MI 480255708 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $17K | $48K | $64K | — |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 30150 TELEGRAPH RD, STE 408 BINGHAM FARMS, MI 480255708 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $3K | $3K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Other fees; Contract Administrator; Consulting (general); Insurance services; Claims processing; Float revenue; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 4520 LINDEN CREEK PKWY FLINT, MI 48507 | $202K |
| GALLAGHER BENEFITS SERVICES EIN 36-4291971 AGENT | Insurance agents and brokers; Insurance brokerage commissions and fees; Other fees; Non-monetary compensation; Other commissions Service code 22 | 30150 TELEGRAPH STE 408 BINGHAM FARMS, MI 480255708 | $97K |
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 | 318 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 319 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 319 | $0 |
| Dental(2 contracts) | DELTA DENTAL OF MICHIGAN | 417 | $164K |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 398 | $24K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA - GROUP LIFE | 319 | $22K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA - ST DISABILITY | 319 | $12K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA - LT DISABILITY | 319 | $30K |
| Other(2 contracts, 2 carriers) | UNUM LIFE - LONG TERM CARE | 319 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 417 | — |
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.