| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EARL JEFFREY SAMS3 Filed as: EARL J SAMS | PO BOX 1748 SAGINAW, MI 486051748 | BLUE CARE NETWORK OF MICHIGAN | $61K | — | $61K | 3.03% |
| SAGINAW BAY UNDERWRITERS3 | 1258 S WASHINGTON SAGINAW, MI 486012509 | BLUE CARE NETWORK OF MICHIGAN | — | $6K | $6K | 0.32% |
| EARL JEFFREY SAMS3 | PO BOX 1748 SAGINAW, MI 48605 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $10K | — | $10K | 1.24% |
| SAGINAW BAY UNDERWRITERS3 | 1258 S WASHINGTON SAGINAW, MI 48601 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $1K | $1K | 0.13% |
| DAVID A RIMBACH3 Filed as: DAVID SLOVES | 2300 CLAYTON RD STE 1450 01 CONCORD, CA 945204520 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $341 | — | $341 | 0.04% |
| EARL C SAMS3 | 1258 S WASHINGTON AVE SAGINAW, MI 48601 | DELTA DENTAL OF MICHIGAN | $9K | — | $9K | 2.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EARL JEFFREY SAMS AGENT/BROKER | Insurance agents and brokers Service code 22 | PO BOX 1748 SAGINAW, MI 48605 | $80K |
| SAGINAW BAY UNDERWRITERS AGENT/BROKER | Insurance agents and brokers Service code 22 | 1258 S WASHINGTON SAGINAW, MI 48601 | $6K |
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 | 290 | 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) | 290 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 494 | $2.8M |
| Dental | DELTA DENTAL OF MICHIGAN | 932 | $289K |
| Vision | VISION SERVICE PLAN | 243 | $81K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 494 | $2.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 932 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.