| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF FLORIDA3 Filed as: BLUE CARE NETWORK OF MICHIGAN | — | BLUE CARE NETWORK OF MICHIGAN | $40K | — | $40K | 2.26% |
| EARL JEFFREY SAMS3 | PO BOX 1748 SAGINAW, MI 48605 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $30K | — | $30K | 4.72% |
| SAGINAW BAY UNDERWRITERS3 | 1258 S WASHINGTON SAGINAW, MI 48601 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $19 | $19 | 0.00% |
| SAGINAW BAY UNDERWRITERS3 Filed as: SAGINAW BAY UNDERWRITERS, INC. | 1258 S WASHINGTON AVE SAGINAW, MI 48601 | DELTA DENTAL OF MICHIGAN | $8K | — | $8K | 2.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EARL JEFFREY SAMS AGENT /BROKER | Other fees; Insurance agents and brokers; Insurance brokerage commissions and fees; Non-monetary compensation; Other commissions Service code 22 | PO BOX 1748 SAGINAW, MI 48601 | $30K |
| SAGINAW BAY UNDERWRITERS | Insurance agents and brokers; Non-monetary compensation; Insurance brokerage commissions and fees; Other fees; Other commissions Service code 22 | 1258 S WASHINGTON SAGINAW, MI 48601 | $19 |
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 | 384 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 384 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 459 | $2.4M |
| Dental | DELTA DENTAL OF MICHIGAN | 856 | $261K |
| Vision | VISION SERVICE PLAN INSURANCE COMPANY | 196 | $68K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 459 | $2.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 856 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.