| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PHILIP ROUTZAHN3 | 3330 BROADMOOR SE STE E GRAND RAPIDS, MI 49512 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $11K | $27K | $39K | 1.46% |
| DOYLE-OGDEN INC3 Filed as: DOYLE & OGDEN INSURANCE | 3230 BROADMOOR, SE GRAND RAPIDS, MI 49512 | DELTA DENTAL | $5K | — | $5K | 3.00% |
| DOYLE-OGDEN INC3 Filed as: DOYLE OGDEN INC | 3330 BROADMOOR SE SUITE E GRAND RAPIDS, MI 49512 | RELIANCE STANDARD LIFE INSURANCE CO | $7K | — | $7K | 7.31% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MI EIN 38-2069753 TPA | Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general); Insurance services; Float revenue; Direct payment from the plan; Contract Administrator; Other fees; Claims processing Service code 12 | — | $211K |
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 | 620 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 620 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 620 | $2.7M |
| Dental | DELTA DENTAL | 602 | $174K |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 620 | $2.7M |
| Short-term disability | BLUE CROSS BLUE SHIELD OF MICHIGAN | 620 | $2.7M |
| Long-term disability | BLUE CROSS BLUE SHIELD OF MICHIGAN | 620 | $2.7M |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 620 | $2.7M |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 620 | $2.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 620 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.