| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HERMAN H KLINGELHOFER3 Filed as: HERMAN H. KLINGELHOFER | 638 DETROIT AVENUE LAKE ORION, MI 48362 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $38K | $24K | $62K | 0.67% |
| HERMAN H KLINGELHOFER3 | 638 DETROIT AVENUE LAKE ORION, MI 48362 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $16K | $10K | $26K | 13.09% |
| HERMAN H KLINGELHOFER3 | 638 DETROIT AVENUE LAKE ORION, MI 48362 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $5K | $12K | 13.28% |
| HERMAN H KLINGELHOFER3 | 638 DETROIT AVENUE LAKE ORION, MI 48362 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $4K | $11K | 13.20% |
| HERMAN H KLINGELHOFER3 | 638 DETROIT AVENUE LAKE ORION, MI 48362 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 12.87% |
| HERMAN H KLINGELHOFER3 | 638 DETROIT AVE LAKE ORION, MI 48362 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $2K | $4K | 13.32% |
| AXA ASSISTANCE, USA5 Filed as: AXA ASSISTANCE USA | 122 SOUTH MICHIGAN AVE., STE. 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $357 | $357 | 24.29% |
| HERMAN H KLINGELHOFER3 Filed as: HERMAN KLINGELHOFER | 638 DETROIT AVE LAKE ORION, MI 48362 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $250 | — | $250 | 17.01% |
No Schedule C service providers reported on this filing.
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 | 992 | 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) | 992 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 992 | $9.3M |
| Dental | BLUE CROSS BLUE SHIELD OF MICHIGAN | 992 | $9.3M |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 992 | $9.3M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 992 | $94K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 833 | $196K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 212 | $31K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 992 | $9.3M |
| Other(4 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,568 | $220K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,568 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.