| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 35371 NETWORK PLACE CHICAGO, IL 60673 | DEARBORN LIFE INSURANCE COMPANY | $67K | — | $67K | 7.57% |
| BENEFIT PROFILES INC3 | 500 CASCADE WEST PARKWAY SE STE 160 GRAND RAPIDS, MI 49546 | DEARBORN LIFE INSURANCE COMPANY | $67K | — | $67K | 7.57% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SERVICES W | 500 N AKARD STREET STE 4300 DALLAS, TX 75201 | DEARBORN LIFE INSURANCE COMPANY | — | $11K | $11K | 1.19% |
| RAYMOND D DEWEY3 | 775 YARD STREET COLUMBUS, OH 43212 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $53K | $43K | $96K | 16.68% |
| DOMINIC SICILIANO3 Filed as: DOMINIC S SICILIANO | 500 CASCADE WEST PARKWAY SE STE 160 GRAND RAPIDS, MI 49546 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $46K | $21K | $68K | 11.76% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SERVICES W | 775 YARD STREET COLUMBUS, OH 43212 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $20K | $20K | 3.44% |
| BENEFIT PROFILES INC3 | 500 CASCADE WEST PARKWAY SE STE 160 GRAND RAPIDS, MI 49546 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $2K | $2K | 0.32% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | PO BOX 416719 BOSTON, MA 02241 | NATIONAL VISION ADMINISTRATORS LLC | $8K | — | $8K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MI EIN 38-2069753 TPA | Direct payment from the plan; Claims processing; Other fees; Insurance services; Contract Administrator; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | — | $859K |
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 | 848 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 848 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 848 | $575K |
| Dental(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 848 | $575K |
| Vision(2 contracts, 2 carriers) | NATIONAL VISION ADMINISTRATORS LLC | 1,591 | $82K |
| Life insurance(3 contracts, 2 carriers) | DEARBORN LIFE INSURANCE COMPANY | 1,422 | $884K |
| Short-term disability | 0 | $0 | |
| Long-term disability | 0 | $0 | |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 848 | $575K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,591 | — |
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.