| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HYLANT GROUP INC3 Filed as: HYLANTGROUP INC | 811 MADISON AVE TOLEDO, OH 43604 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $41K | — | $41K | 4.76% |
| HYLANT GROUP INC3 | PO BOX 541 ANN ARBOR, MI 48106 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $10K | — | $10K | 1.12% |
| HYLANT GROUP INC3 | 8 CADILLAS DR STE 230 BRENTWOOD, TN 37027 | DELTA DENTAL OF MICHIGAN | $11K | — | $11K | 1.99% |
| HYLANT GROUP INC3 | 811 MADISON AVE TOLDEO, OH 43604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 1.81% |
| HYLANT GROUP INC3 | 811 MADISON AVE TOLEDO, OH 43604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | — | $6K | 3.59% |
| HYLANT GROUP INC3 Filed as: HYLANT GROUP IN | 811 MADISON AVE TOLEDO, OH 43603 | VISION SERVICE PLAN | $3K | — | $3K | 2.55% |
| HYLANT GROUP INC3 Filed as: HYLANT GROUP IN | 811 MADISON AVE TOLEDO, OH 43604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHEILD EIN 38-2069753 TPA | Insurance services; Consulting (general); Contract Administrator; Direct payment from the plan; Claims processing; Other fees; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $727K |
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA RX DISPENSING FEES | Non-monetary compensation Service code 56 | — | $6K |
| HYLANT GROUP INC AGENT/BROKER | Insurance agents and brokers; Other fees; Insurance brokerage commissions and fees; Non-monetary compensation; Other commissions Service code 22 | 811 MADISON AVE TOLEDO, OH 43604 | $0 |
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 | 1,112 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,118 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | GRAND VALLEY HEALTH PLAN | 60 | $520K |
| Dental | DELTA DENTAL OF MICHIGAN | 1,176 | $575K |
| Vision | VISION SERVICE PLAN | 885 | $103K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,314 | $268K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,314 | $155K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,118 | $853K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,314 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,314 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.