| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT W OWEN3 Filed as: ROBERT E. PETCOVE | 100 MATSONFORD ROAD 3 RADNOR CORPORATE CENTER RADNOR, PA 19087 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $47K | $0 | $47K | 2.98% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 100 MATSONFORD ROAD 3 RADNOR CORPORATE CENTER RADNOR, PA 19087 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $1K | $1K | 0.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $0 | $7K | 6.55% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $2K | $2K | 1.64% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 4TH FLOOR ROLLING MEADOWS, IL 60008 | DELTA DENTAL OF MICHIGAN | $5K | $0 | $5K | 6.19% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | VISION SERVICE PLAN | $978 | $0 | $978 | 6.07% |
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 | 127 | 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) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 209 | $1.6M |
| Dental | DELTA DENTAL OF MICHIGAN | 210 | $87K |
| Vision | VISION SERVICE PLAN | 114 | $16K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 127 | $100K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 127 | $100K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 209 | $1.6M |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 127 | $100K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 210 | — |
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.