| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JASON A. FREEMAN3 Filed as: JASON FREEMAN | 24 FRANK LLOYD WRIGHT DR ANN ARBOR, MI 481059484 | BLUE CARE NETWORK | $16K | — | $16K | 4.75% |
| HYLANT GROUP INC3 | 8 CADILLAC DR STE 230 BRENTWOOD, TN 37027 | DELTA DENTAL OF MICHIGAN | $7K | — | $7K | 4.92% |
| HYLANT GROUP INC3 | 811 MADISON AVE 8TH FL TOLEDO, OH 43604 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $5K | $3K | $8K | 18.74% |
| HYLANT GROUP INC3 | 811 MADISON AVE 8TH FL TOLEDO, OH 43604 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | $3K | $7K | 15.51% |
| HYLANT GROUP INC3 | 811 MADISON AVE 8TH FL TOLEDO, OH 43604 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | $2K | $6K | 22.22% |
| HYLANT GROUP INC3 | 811 MADISON AVE 8TH FL TOLEDO, OH 43604 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | $558 | $3K | 19.04% |
| HYLANT GROUP INC3 | 811 MADISON AVE 8TH FL TOLEDO, OH 43604 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | $738 | $2K | 17.61% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing; Consulting (general); Insurance services; Direct payment from the plan; Other fees; Contract Administrator Service code 12 | — | $130K |
| JASON FREEMAN AGENT | Insurance agents and brokers; Other commissions; Other fees; Non-monetary compensation; Insurance brokerage commissions and fees Service code 22 | 24 FRANK LLOYD WRIGHT DR STE J4100 ANN ARBOR, MI 481059484 | $31K |
| BCI ADMINISTRATORS EIN 38-3349153 TPA | Claims processing; Contract Administrator; Other fees; Direct payment from the plan; Insurance services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general) Service code 12 | — | $11K |
| HYLANT GROUP INC ANN ARBOR AGENCY | Other fees; Insurance agents and brokers; Insurance brokerage commissions and fees; Non-monetary compensation; Other commissions Service code 22 | PO BOX 541 ANN ARBOR, MI 481060541 | $4K |
| EHIM EIN 38-2776173 TPA | Claims processing; Float revenue; Other fees; Contract Administrator; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general); Insurance services Service code 12 | — | $2K |
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 | 198 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 198 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CARE NETWORK | 66 | $335K |
| Dental | DELTA DENTAL OF MICHIGAN | 445 | $150K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 200 | $44K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 81 | $12K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 200 | $44K |
| Prescription drug | BLUE CARE NETWORK | 66 | $335K |
| Other(4 contracts, 2 carriers) | BLUE CARE NETWORK | 200 | $422K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 445 | — |
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.