| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASR HEALTH BENEFITS3 | 618 KENMOOR AVENUE SE SUITE 200 GRAND RAPIDS, MI 49546 | ARDELLIS | $120K | — | $120K | 17.97% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC. | 333 INDUSTRIAL DRIVE P.O. BOX 1801 ADRIAN, MI 492218780 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $33K | $8K | $41K | 18.63% |
| KAPNICK & COMPANY, INC.3 | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 48108 | DELTA DENTAL OF MICHIGAN | $6K | $457 | $6K | 4.54% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK AND CO. INC. | 333 INDUSTRIAL DRIVE ADRIAN, MI 492218780 | VISION SERVICE PLAN | $4K | — | $4K | 9.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ASR HEALTH BENEFITS EIN 38-2651185 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $240K |
| CVS HEALTH EIN 05-0340626 PHARMACY BENEFITS MANAGE | Contract Administrator Service code 13 | — | $14K |
| PARKVIEW EIN 35-1996535 PREFERRED PROVIDER NETWO | Other services Service code 49 | — | $158 |
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 | 6 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 378 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 384 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF MICHIGAN | 707 | $139K |
| Vision | VISION SERVICE PLAN | 266 | $45K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 378 | $222K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 378 | $222K |
| Stop-loss / reinsurancereinsurance | ARDELLIS | 335 | $669K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 378 | $222K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 707 | — |
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.