| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TIMBERLAND GROUP SERVICES, INC.3 | 1707 W. BIG BEAVER ROAD TROY, MI 48084 | DELTA DENTAL OF MICHIGAN | $6K | — | $6K | 4.75% |
| TIMBERLAND GROUP SERVICES, INC.3 | 1707 W. BIG BEAVER ROAD TROY, MI 48084 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 10.00% |
| TIMBERLAND GROUP SERVICES, INC.3 | 1707 W. BIG BEAVER ROAD TROY, MI 48084 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 10.00% |
| TIMBERLAND GROUP SERVICES, INC.3 | 1707 W. BIG BEAVER ROAD TROY, MI 48084 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| TIMBERLAND GROUP SERVICES, INC.3 | 1707 W. BIG BEAVER ROAD TROY, MI 48084 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| UNITED OF OMAHA LIFE INSURANCE CO0 Filed as: UNITED OF OMAHA LIFE INSURANCE COMP | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $9K | $9K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Insurance services; Consulting (general); Contract Administrator; Direct payment from the plan; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $161K |
| EMPLOYEE HEALTH INSURANCE MGT, INC. EIN 38-2776173 RX ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $10K |
| JOSEPH A KING BROKER | Non-monetary compensation; Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | 1707 W. BIG BEAVER ROAD TROY, MI 48084 | $10K |
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 | 191 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 193 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF MICHIGAN | 447 | $131K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 191 | $33K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 191 | $84K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 141 | $29K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 141 | $37K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 447 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.