| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RICHARD GRENAY3 Filed as: RICHARD J. GRENAY | 2250 KILDARE DR DAVISON, MI 48423 | NATIONWIDE LIFE INSURANCE COMPANY | $3K | — | $3K | 4.85% |
| CHARLES D. BLOCK3 Filed as: CHARLES KORTH | 3256 UNIVERSITY DR SUITE 35 AUBURN HILLS, MA 48326 | NATIONAL GUARDIAN LIFE | $576 | — | $576 | 3.73% |
| UNITED OF OMAHA LIFE INSURANCE CO3 Filed as: MUTUAL OF OMAHA MARKETING CORP | 3300 MUTAL OF OMAHA PLAZA OMAHA, NE 68175 | NATIONAL GUARDIAN LIFE | $191 | — | $191 | 1.24% |
| CHARLES D. BLOCK3 Filed as: CHARLES KORTH | 3256 UNIVERSITY DR SUITE 35 AUBURN HILLS, MA 48326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | — | $0 | — |
| CHARLES E. KORTH3 | 3256 UNIVERSITY DRIVE, SUITE 35 AUBURN HILLS, MI 48326 | HEALTHPLUS INSURANCE COMPANY | — | — | $0 | — |
| RICHARD GRENAY3 | 3256 UNIVERSITY DRIVE, SUITE 35 AUBURN HILLS, MI 48326 | HEALTHPLUS INSURANCE COMPANY | — | — | $0 | — |
| CHARLES D. BLOCK3 Filed as: CHARLES KORTH | 3256 UNIVERSITY DR SUITE 35 AUBURN HILLS, MI 48326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | — | $0 | — |
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 | 115 | 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) | 115 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTHPLUS INSURANCE COMPANY | 99 | $0 |
| Dental | NATIONWIDE LIFE INSURANCE COMPANY | 84 | $61K |
| Vision | NATIONAL GUARDIAN LIFE | 86 | $15K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 115 | $0 |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 115 | $0 |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 115 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 115 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.