| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ERIKA L EBERLY3 | 333 INDUSTRIAL DRIVE ADRIAN, MI 492218780 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $8K | $24K | $32K | 12.43% |
| KAPNICK & COMPANY, INC.3 | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 481081690 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $2K | $2K | 0.58% |
| KAPNICK & COMPANY, INC.3 | 1201 BRIARWOOD CIR ANN ARBOR, MI 48108 | DELTA DENTAL OF MICHIGAN | $6K | — | $6K | 4.68% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Other fees; Claims processing; Contract Administrator; Insurance services; Consulting (general) Service code 12 | — | $105K |
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 | 100 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF MICHIGAN | 309 | $126K |
| Vision(2 contracts) | VISION SERVICE PLAN | 85 | $13K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 317 | $260K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 317 | — |
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.