| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRICIA SULLIVAN FORLETTA3 | 2600 SOUTH TELEGRAPH ROAD SUITE 100 BLOOMFIELD HILLS, MI 48302 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $70K | — | $70K | 1.49% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2600 SOUTH TELEGRAPH, SUITE 100 BLOOMFIELD HILLS, MI 48302 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $6K | $6K | 0.12% |
| JORDON WERTHEIMER3 Filed as: JORDON L. WERTHEIMER | 901 WILSHIRE DRIVE, SUITE 300 TROY, MI 48084 | KANSAS CITY LIFE INSURANCE COMPANY | $34K | $0 | $34K | 8.20% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 4TH FLOOR ROLLING MEADOWS, IL 60008 | DELTA DENTAL OF MICHIGAN | $20K | $0 | $20K | 4.91% |
| PATRICIA SULLIVAN FORLETTA3 | 2600 SOUTH TELEGRAPH ROAD SUITE 100 BLOOMFIELD HILLS, MI 48302 | BLUE CARE NETWORK OF MICHIGAN | $4K | $0 | $4K | 1.60% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2600 SOUTH TELEGRAPH, SUITE 100 BLOOMFIELD HILLS, MI 48302 | BLUE CARE NETWORK OF MICHIGAN | $0 | $392 | $392 | 0.17% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2600 SOUTH TELEGRAPH ROAD BLOOMFIELD HILLS, MI 48302 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $10K | $0 | $10K | 11.91% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $591 | $0 | $591 | 0.72% |
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 | 629 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 63 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 692 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 969 | $4.9M |
| Dental | DELTA DENTAL OF MICHIGAN | 999 | $413K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 881 | $82K |
| Life insurance | KANSAS CITY LIFE INSURANCE COMPANY | 623 | $419K |
| Short-term disability | KANSAS CITY LIFE INSURANCE COMPANY | 623 | $419K |
| Long-term disability | KANSAS CITY LIFE INSURANCE COMPANY | 623 | $419K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 969 | $4.9M |
| Other | KANSAS CITY LIFE INSURANCE COMPANY | 623 | $419K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 999 | — |
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.