| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES P LILL | 760 PASQUINELLI DR STE 358 WESTMONT, IL 60559 | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | $55K | — | $55K | 5.25% |
| MID AMERICAN GROUP, INC.3 Filed as: MID AMERICAN GROUP, INC | 760 PASQUINELLI DRIVE 358 WESTMONT, IL 60559 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $22K | $156K | $178K | 52.57% |
| MID AMERICAN GROUP, INC.3 Filed as: MID AMERICAN GROUP, INC | 760 PASQUINELLI DRIVE 358 WESTMONT, IL 60559 | HARTFORD LIFE AND ACCIDENT | $68K | — | $68K | 20.55% |
| MIDAMERICAN GROUP, INC3 | 760 PASQUINELLI DRIVE 358 WESTMONT, IL 60559 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $8K | — | $8K | 9.98% |
| MID AMERICAN GROUP, INC.3 | 760 PASQUINELLI DRIVE 358 WESTMONT, IL 60559 | DEARBORN NATIONAL LIFE INSURANCE CO | $32K | — | $32K | 52.48% |
| MIDAMERICAN GROUP, INC3 | 760 PASQUINELLI DRIVE 358 WESTMONT, IL 60559 | PRUDENTIAL | $7K | — | $7K | 17.48% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 THIRD PARTY ADMINISTRATOR | Other fees; Direct payment from the plan; Contract Administrator; Claims processing; Insurance services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general) Service code 12 | 600 EAST LAFAYETTE STREET DETROIT, MI 48226 | $664K |
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 | 1,771 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 852 | $339K |
| Dental | DEARBORN NATIONAL LIFE INSURANCE CO | 716 | $60K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 1,367 | $78K |
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 1,771 | $374K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 1,771 | $331K |
| Long-term disability(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 1,771 | $374K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 852 | $339K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 852 | $339K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 1,771 | $374K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,771 | — |
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.