| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DOUGLAS H ROEHM3 | 5925 MERIDAN BOULEVARD SUITE 300 BRIGHTON, MI 48116 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $29K | — | $29K | 4.79% |
| ACTION BENEFITS COMPANY3 | 24600 NORTHWESTERN SOUTHFIELD, MI 48075 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $6K | — | $6K | 1.02% |
| DIANE D. WHEELOCK3 Filed as: DIANE D WHEELOCK | 120 WEST SAGINAW EAST LANSING, MI 48854 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $73 | $73 | 0.01% |
| DOUG ROEHM - SHERYL LANGFORD3 | 245 BARCLAY CIRCLE STE 200 ROCHESTER HILLS, MI 48307 | KANSAS CITY LIFE INSURANCE COMPANY | $8K | — | $8K | 12.43% |
| PHYSICIAN SERVICE GROUP, INC.3 | 120 WEST SAGINAW STREET EAST LANSING, MI 48823 | DELTA DENTAL OF MICHIGAN | $4K | — | $4K | 6.09% |
| MSMS PHYSICIANS INSURANCE AGENCY3 Filed as: MSMS-PHYSICIANS INSURANCE AGENCY | 120 W SAGINAW ST EAST LANSING, MI 48823 | VISION SERVICE PLAN | $689 | — | $689 | 6.42% |
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 | 164 | 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. |
| Total participants (= "Plan participants" tile) | 164 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 213 | $601K |
| Dental | DELTA DENTAL OF MICHIGAN | 215 | $64K |
| Vision | VISION SERVICE PLAN | 94 | $11K |
| Life insurance | KANSAS CITY LIFE INSURANCE COMPANY | 160 | $65K |
| Short-term disability | KANSAS CITY LIFE INSURANCE COMPANY | 160 | $65K |
| Long-term disability | KANSAS CITY LIFE INSURANCE COMPANY | 160 | $65K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 213 | $601K |
| Other | KANSAS CITY LIFE INSURANCE COMPANY | 160 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 215 | — |
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.