| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GULAINE DONAVAN3 | 811 MADISON AVE TOLEDO, OH 43604 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $32K | — | $32K | 3.21% |
| HYLANT GROUP INC3 Filed as: HYLANT GROUP INC ANN ARBOR | PO BOX 541 ANN ARBOR, MI 48106 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $17K | $17K | 1.74% |
| KAREN BARNES3 Filed as: KAREN RENEE BARNES | 811 MADISON AVE TOLEDO, OH 43604 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $3K | — | $3K | 0.30% |
| HYLANT GROUP INC3 | 8 CADILLAC DR STE 230 BRENTWOOD, TN 37027 | DELTA DENTAL OF MICHIGAN | $13K | — | $13K | 2.19% |
| HYLANT GROUP INC3 | 811 MADISON AVE TOLEDO, OH 43604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 1.87% |
| HYLANT GROUP INC3 | 811 MADISON AVE TOLEDO, OH 43604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | — | $6K | 3.58% |
| HYLANT GROUP INC3 | 811 MADISON AVE TOLEDO, OH 43603 | VISION SERVICE PLAN | $3K | — | $3K | 2.05% |
| HYLANT GROUP INC3 | 811 MADISON AVE TOLEDO, OH 43604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 12.61% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Non-monetary compensation; Insurance services; Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Direct payment from the plan; Claims processing; Consulting (general) Service code 12 | 600 LAFAYETTE EAST DETRIOT, MI 48226 | $746K |
| GUYLAINE DONAVAN AGENT/BROKER | Other commissions; Non-monetary compensation; Other fees; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | 811 MADISON AVE TOLEDO, OH 43604 | $0 |
| HYLANT GROUPD INC ANN ARBOR AGENT/BROKER | Other fees; Other commissions; Insurance brokerage commissions and fees; Non-monetary compensation; Insurance agents and brokers Service code 22 | PO BOX 541 ANN ARBOR, MI 48106 | $0 |
| KAREN RENEE BARNES AGENT/BROKER | Non-monetary compensation; Insurance agents and brokers; Other fees; Other commissions; Insurance brokerage commissions and fees 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 | 1,390 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,395 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | GRAND VALLEY HEALTH PLAN | 39 | $30K |
| Dental | DELTA DENTAL OF MICHIGAN | 2,509 | $593K |
| Vision | VISION SERVICE PLAN | 915 | $132K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,390 | $255K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,390 | $155K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,118 | $1.0M |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,390 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,509 | — |
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.