| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HERMAN H KLINGELHOFER3 | 638 DETROIT AVENUE LAKE ORION, MI 48362 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $10K | $18K | $28K | 1.74% |
| HERMAN H KLINGELHOFER3 Filed as: HERMAN KLINGELHOFER | 638 DETROIT AVE. LAKE ORION, MI 48362 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 15.00% |
| HERMAN H KLINGELHOFER3 | 638 DETROIT AVENUE LAKE ORION, MI 48362 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 5.00% |
| HERMAN H KLINGELHOFER3 | 638 DETROIT AVE. LAKE ORION, MI 48362 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 5.00% |
| HERMAN H KLINGELHOFER3 Filed as: HERMAN H KLINGELHOFER JR. | 638 DETROIT AVE LAKE ORION, MI 48362 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $996 | — | $996 | 5.00% |
| HERMAN H KLINGELHOFER3 | 638 DETROIT AVE. LAKE ORION, MI 48362 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $302 | — | $302 | 5.00% |
No Schedule C service providers reported on this filing.
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 | 171 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 171 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 151 | $1.6M |
| Dental | BLUE CROSS BLUE SHIELD OF MICHIGAN | 151 | $1.6M |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 151 | $1.6M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 75 | $36K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 114 | $24K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 57 | $26K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 151 | $1.6M |
| Other(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 171 | $1.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 171 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.