| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY | 333 INDUSTRIAL DR PO BOX 1801 ADRIAN, MI 49221 | HEALTH ALLIANCE PLAN | $45K | — | $45K | 3.03% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY, INC | 1201 BRIARWOOD CIR ANN ARBOR, MI 48108 | DELTA DENTAL OF MICHIGAN | $655 | — | $655 | 0.59% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | DELTA DENTAL OF MICHIGAN | $219 | — | $219 | 0.20% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DR PO BOX 1801 ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $5K | 14.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $673 | $2K | 5.85% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DR PO BOX 1801 ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $823 | $3K | 12.90% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $854 | $470 | $1K | 5.34% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & CO INC | PO BOX 1801 ADRIAN, MI 49221 | VISION SERVICE PLAN | $930 | — | $930 | 4.62% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | VISION SERVICE PLAN | $180 | — | $180 | 0.89% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DR PO BOX 1801 ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $659 | $2K | 10.90% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $488 | $377 | $865 | 4.55% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DR PO BOX 1801 ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $556 | $2K | 10.54% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $458 | $318 | $776 | 4.31% |
| SCHILLER & ASSOCIATES LLC4 | 173 COTTAGE LN MILFORD, MI 48381 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $2K | — | $2K | 14.15% |
| ANTHONY P PETRILL4 | 2700 OLD STABLES DR CELINA, TX 75009 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $211 | — | $211 | 1.64% |
| KELLY M TIMMONS4 | 4205 OXFORD DR COLUMBUS, OH 43220 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $184 | — | $184 | 1.43% |
| TONYA DEAN PETRILL4 | 2700 OLD STABLES DR CELINA, TX 75009 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $130 | — | $130 | 1.01% |
| CHARLES D. DAHL4 Filed as: CHARLES D DAHL | 1212 ADA ST OWOSSO, MI 48867 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $19 | — | $19 | 0.15% |
| MARGARET ANDERTON4 | 5483 BULL RUN DR BIRMINGHAM, AL 35210 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $13 | — | $13 | 0.10% |
| ADAM RICCINTO4 | 722 E CROSS ST YPSILANTI, MI 48198 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $12 | — | $12 | 0.09% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK AND COMPANY, INC | 333 INDUSTRIAL DR ADRIAN, MI 49221 | AFLAC | $2K | — | $2K | 47.96% |
| SHALIN KLUG3 | 9868 HIGH MEADOW DR YPSILANTI, MI 48198 | AFLAC | $135 | — | $135 | 2.81% |
| DANIEL MACDONALD3 | 28655 OAKMONTE CIR W NEW HUDSON, MI 48165 | AFLAC | $134 | — | $134 | 2.79% |
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 | 118 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 121 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH ALLIANCE PLAN | 267 | $1.5M |
| Dental | DELTA DENTAL OF MICHIGAN | 279 | $111K |
| Vision | VISION SERVICE PLAN | 102 | $20K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 114 | $18K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 81 | $19K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 114 | $25K |
| Other(4 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 114 | $67K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 279 | — |
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.