| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EARL JEFFREY SAMS3 | P.O. BOX 1748 SAGINAW, MI 48605 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $6K | $28K | $34K | 19.15% |
| STEVEN WHITE3 Filed as: STEVEN M WHITE | 25882 ORCHARD LAKE 203 FARMINGTON HILLS, MI 48336 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $924 | — | $924 | 0.51% |
| SAGINAW BAY UNDERWRITERS3 Filed as: SAGINAW BAY UNDERWRITERS, INC | 1258 S WASHINGTON AVE SAGINAW, MI 48601 | DELTA DENTAL OF MICHIGAN | $6K | — | $6K | 4.79% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Claims processing; Direct payment from the plan; Contract Administrator; Float revenue; Consulting (general); Insurance services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees Service code 12 | — | $149K |
| EARL SAMS INSURANCE AGENT | Other commissions; Non-monetary compensation; Insurance brokerage commissions and fees; Other fees; Insurance agents and brokers Service code 22 | PO BOX 1748 SAGINAW, MI 48605 | $40K |
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 | 202 | 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) | 202 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 167 | $180K |
| Dental | DELTA DENTAL OF MICHIGAN | 324 | $119K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 324 | — |
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.