| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GARY M. MIKLOSOVIC3 | 30150 TELEGRAPH ROAD, SUITE 408 BINGHAM FARMS, MI 48025 | BLUE CARE NETWORK OF MICHIGAN | $15K | $0 | $15K | 1.17% |
| EDGAR MARK GREGORY3 Filed as: EDGAR M. IV. GREGORY | 30150 TELEGRAPH ROAD, SUITE 408 BINGHAM FARMS, MI 48025 | BLUE CARE NETWORK OF MICHIGAN | $8K | $0 | $8K | 0.60% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 30150 TELEGRAPH ROAD, SUITE 408 BINGHAM FARMS, MI 48025 | BLUE CARE NETWORK OF MICHIGAN | $0 | $3K | $3K | 0.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 30150 TELEGRAPH ROAD, SUITE 408 BINGHAM FARMS, MI 48025 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $75 | $75 | 0.07% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 3.94% |
| GARY M. MIKLOSOVIC3 | 30150 TELEGRAPH ROAD, SUITE 408 BINGHAM FARMS, MI 48025 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $110 | $0 | $110 | 0.70% |
| SHILLER AND ASSOCIATES, LLC4 | 173 COTTAGE LANE MILFORD, MI 48381 | PREPAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $2K | $0 | $2K | 14.89% |
| KELLY M TIMMONS4 Filed as: KELLY M. TIMMONS | PO BOX 21608 COLUMBUS, OH 43221 | PREPAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $199 | $0 | $199 | 1.49% |
| ANTHONY P PETRILL4 Filed as: ANTHONY P. PETRILL | 1613 LOOKOUT CIRCLE WAXHAW, NC 28173 | PREPAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $150 | $0 | $150 | 1.12% |
| TONYA DEAN PETRILL4 | 1613 LOOKOUT CIRCLE WAXHAW, NC 28173 | PREPAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $136 | $0 | $136 | 1.02% |
| CHARLES D. DAHL4 | 1212 ADA STREET OWOSSO, MI 48867 | PREPAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $21 | $0 | $21 | 0.16% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK AND COMPANY, INC. | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | AFLAC | $884 | $0 | $884 | 13.63% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $206 | $0 | $206 | 3.18% |
| BETH J. SOMMERS3 | 2075 ELLWOOD AVENUE BERKLEY, MI 48072 | AFLAC | $129 | $0 | $129 | 1.99% |
| DANIEL MACDONALD3 Filed as: DANIEL E. MACDONALD | 28655 OAKMONTE CIRCLE WEST NEW HUDSON, MI 48165 | AFLAC | $36 | $38 | $74 | 1.14% |
| SHAUN M KLUG3 Filed as: SHAUN M. KLIG | 46389 SPINNING WHEEL DRIVE CANTON, MI 48187 | AFLAC | $34 | $38 | $72 | 1.11% |
| MJ INSURANCE3 Filed as: BETH J. SOMMERS AND VARIOUS AGENTS | 255 MEADOWVIEW DRIVE ATTICA, MI 48412 | AFLAC | $59 | $0 | $59 | 0.91% |
| MIKE MCCORMICK3 Filed as: MIKE HOOVER | 206 LAKE STREET ELK RAPIDS, MI 49629 | AFLAC | $30 | $0 | $30 | 0.46% |
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 | 112 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 260 | $1.3M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 343 | $107K |
| Vision | VISION SERVICE PLAN | 94 | $16K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $84K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $84K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $84K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 260 | $1.3M |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $103K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 343 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.