| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SUSAN L CULHANE3 | 5579 STADIUM DR KALAMAZOO, MI 49009 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $13K | $24K | $36K | 9.70% |
| RYAN A COLVIN3 | 130 S MAIN ST STE 400 SOUTH BEND, IN 46601 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $14K | $14K | 3.67% |
| GIBSON INSURANCE AGENCY, INC.3 | 130 S MAIN ST STE 400 SOUTH BEND, IN 46601 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $1K | $1K | 0.34% |
| THE NULTY AGENCY INC.3 Filed as: THE NULTY AGENCY INC | 5579 STADIUM DR KALAMAZOO, MD 49009 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | — | $7K | 10.00% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | PO BOX 11177 SOUTH BEND, IN 46634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 2.67% |
| THE NULTY AGENCY INC.3 Filed as: THE NULTY AGENCY INC | 5579 STADIUM DR KALAMAZOO, MI 49009 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 15.00% |
| GIBSON INSURANCE AGENCY, INC.3 | PO BOX 11177 SOUTH BEND, IN 46634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 4.26% |
| THE NULTY AGENCY INC.3 Filed as: THE NULTY AGENCY | 5579 STADIUM DR KALAMAZOO, MI 49009 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 17.00% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | PO BOX 11177 SOUTH BEND, IN 46634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 5.75% |
| THE NULTY AGENCY INC.3 Filed as: THE NULTY AGENCY INC | 5579 STADIUM DR KALAMAZOO, MI 49009 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 15.00% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | PO BOX 11177 SOUTH BEND, IN 46634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 6.21% |
| THE NULTY AGENCY INC.3 Filed as: THE NULTY AGENCY | 5579 STADIUM DR KALAMAZOO, MI 49009 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $987 | — | $987 | 10.00% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | PO BOX 11177 SOUTH BEND, IN 46634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $555 | $555 | 5.62% |
| THE NULTY AGENCY INC.3 Filed as: THE NULTY AGENCY | 5579 STADIUM DR KALAMAZOO, MI 49009 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $957 | — | $957 | 15.01% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | PO BOX 11177 SOUTH BEND, IN 46634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $344 | $344 | 5.39% |
| THE NULTY AGENCY INC.3 Filed as: THE NULTY AGENCY INC | 5579 STADIUM DR KALAMAZOO, MI 49009 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $368 | — | $368 | 15.00% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC. | PO BOX 11177 SOUTH BEND, IN 46634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $49 | $49 | 2.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Other fees; Contract Administrator; Consulting (general); Insurance services; Claims processing; Float revenue; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $107K |
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 | 181 | 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) | 181 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 196 | $375K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 102 | $66K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 88 | $10K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 72 | $28K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 181 | $34K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 40 | $19K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 196 | $375K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 196 | $375K |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 72 | $36K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 196 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.