| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TIMOTHY J HOLSWORTH3 | 1601 MARQUETTE ST STE4 BAY CITY, MI 487064196 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $28K | — | $28K | 3.26% |
| CAREN RUTH LIEBERMAN3 | 4406 MAR MOOR DR LANSING, MI 48917 | AFLAC | $729 | — | $729 | 6.97% |
| MYRNA L MURRAY3 | 2114 BOSTON BLVD STE 2 LANSING, MI 48910 | AFLAC | $215 | — | $215 | 2.06% |
| RONALD A DASHKOVITZ3 Filed as: RONALD ALLEN DASHKOVITZ | 139 W LAKE LANSING RD STE 200 EAST LANSING, MI 48823 | AFLAC | $103 | — | $103 | 0.98% |
| SEAN NASTASE3 | 108 RESIDENCES LN UNIT 103 CHARLESTON, SC 29414 | AFLAC | $83 | — | $83 | 0.79% |
| ALAN BERGMANN3 | 461 COKESBURY DR THE VILLAGES, FL 32162 | AFLAC | $40 | — | $40 | 0.38% |
| CHARLES E NORRIS3 | 5153 WINSOR WAY GLADWIN, MI 48624 | AFLAC | $27 | — | $27 | 0.26% |
| LARRY M FELTEN3 | PO BOX 6505 SAGINAW, MI 48608 | AFLAC | $25 | — | $25 | 0.24% |
| DOUGLAS MARTIN BELSER3 | 26211 INDIANA AVE NOVI, MI 48374 | AFLAC | $24 | — | $24 | 0.23% |
| AMBER DASHKOVITZ3 | 1901 N FAIRVIEW AVE LANSING, MI 48912 | AFLAC | $23 | — | $23 | 0.22% |
| AMY SUE MCKENZIE CRUMBAUGH3 | 5742 N STATE RD ALMA, MI 48801 | AFLAC | $22 | — | $22 | 0.21% |
| JAMES H RAIRIGH3 Filed as: JAMES L SURPRENANT | 2156 KEWAUNEE CT. TRAVERSE CITY, MI 49686 | AFLAC | $21 | — | $21 | 0.20% |
| ASHLEY ANN FOX3 | PO BOX 31 311 W ORCHARD AVE SHEPHERD, MI 48883 | AFLAC | $16 | — | $16 | 0.15% |
| BRADLEY J LOWRAN3 | 9553 E WALKABOUT LN TRAVERSE CITY, MI 49684 | AFLAC | $13 | — | $13 | 0.12% |
| JASON L GLICK3 | 7628 GRATIOT RD RM 101 SAGINAW, MI 48609 | AFLAC | $13 | — | $13 | 0.12% |
| ANDREW K GLAUB3 | PO BOX 339 BELLAIRE, MI 49615 | AFLAC | $12 | — | $12 | 0.11% |
| MATTHEW THOMAS NEMODE3 | 815 E MIDLAND ST BAY CITY, MI 48706 | AFLAC | $11 | — | $11 | 0.11% |
| PEGGY S DISS3 | 224 TREVINO CT NORTH FORT MYERS, FL 33903 | AFLAC | $9 | — | $9 | 0.09% |
| JULIE SLAUGHTER3 Filed as: JULIE M SLAUGHTER | 31211 GRANDON ST LIVONIA, MI 48150 | AFLAC | $8 | — | $8 | 0.08% |
| MONTANA TOMPKINS | 6301 GARDENIA AVE LANSING, MI 48911 | AFLAC | $8 | — | $8 | 0.08% |
| AG AND ASSOCIATES3 | PO BOX 339 BELLAIRE, MI 49615 | AFLAC | $7 | — | $7 | 0.07% |
| DUANE E CORDES3 | PO BOX 455 HILLMAN, MI 49746 | AFLAC | $6 | — | $6 | 0.06% |
| GERALD THORP AGENCY LLC3 Filed as: GERALD F THORP II | 1582 RILEY RD CARO, MI 48723 | AFLAC | $4 | — | $4 | 0.04% |
| MATTHEW P JOHNSON3 | 1002 W GRAND RIVER AVE WILLIAMSTON, MI 48895 | AFLAC | $1 | — | $1 | 0.01% |
| DOUGLAS E FOX3 Filed as: DOUGLAS EDWARD FOX | 6836 THAYER LAKE DR. ALDEN, MI 49612 | AFLAC | $1 | — | $1 | 0.01% |
| HEATHER A DOLLIVER3 | 2150 ASSOCIATION DR OKEMOS, MI 48864 | AFLAC | $1 | — | $1 | 0.01% |
| DANIEL M WOLF3 | PO BOX 121 ISHPEMING, MI 49849 | AFLAC | $1 | — | $1 | 0.01% |
| CHRISTOPHER D BOULDREY3 | 448 RIVER WOODS DR FLUSHING, MI 48433 | AFLAC | $1 | — | $1 | 0.01% |
| ANNIE GLAUB3 | PO BOX 339 BELLAIRE, MI 49615 | AFLAC | $1 | — | $1 | 0.01% |
| JAMES BULLOCK3 | 6144 W LONGVIEW DR EAST LANSING, MI 48823 | AFLAC | $1 | — | $1 | 0.01% |
| JAMES C SNIDER JR3 | 20817 POINTE REGATTA DR CORNELIUS, NC 28031 | AFLAC | $1 | — | $1 | 0.01% |
| RANDALL L KIMBLER3 | PO BOX 302 HESPERIA, MI 49421 | AFLAC | $1 | — | $1 | 0.01% |
| GREGORY CRAWFORD3 | PO BOX 1471 MIDLAND, MI 48641 | AFLAC | $1 | — | $1 | 0.01% |
| JEFFREY C WERNER3 | 4430 GLENCOE DR WILLIAMSTON, MI 48895 | AFLAC | $1 | — | $1 | 0.01% |
| STEPHANIE L KESSELRING3 | 5434 OAKHURST DR SEMINOLE, FL 33772 | AFLAC | $1 | — | $1 | 0.01% |
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 | 127 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 128 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 196 | $861K |
| Dental | BLUE CROSS BLUE SHIELD OF MICHIGAN | 196 | $858K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 196 | $858K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 196 | $861K |
| Other | AFLAC | 16 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 196 | — |
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.