| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ELAINE C. COFFMAN3 | 325 NORTH OLD WOODWARD AVENUE SUITE 370 BIRMINGHAM, MI 48009 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $24K | $0 | $24K | 1.87% |
| ROBERT HUGHES3 Filed as: ROBERT B. HURD | 120 WEST DRIVE, SUITE 3 MARSHALL, MI 49068 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $18K | $0 | $18K | 1.37% |
| STRATEGIC BENEFITS NETWORK LLC3 Filed as: STRATEGIC BENEFITS NETWORK, LLC | 5797 HARVEY STREET, SUITE A NORTON SHORES, MI 49444 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $2K | $2K | 0.14% |
| ROBERT HUGHES3 Filed as: ROBERT B. HURD | 120 WEST DRIVE, SUITE 3 MARSHALL, MI 49068 | DELTA DENTAL OF MICHIGAN | $3K | $0 | $3K | 3.81% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | DELTA DENTAL OF MICHIGAN | $2K | $0 | $2K | 2.54% |
| ROBERT HUGHES3 Filed as: ROBERT B. HURD | 120 WEST DRIVE, SUITE 3 MARSHALL, MI 49068 | METROPOLITAN LIFE INSURANCE COMPANY | $7K | $0 | $7K | 9.98% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $1K | $5K | 6.82% |
| LOCKTON COMPANIES, LLC3 | PO BOX 843844 KANSAS CITY, MO 64184 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $129 | $4K | 5.19% |
| LOCKTON COMPANIES, LLC3 | PO BOX 650823 DALLAS, TX 75265 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $250 | $250 | 0.33% |
| LOCKTON COMPANIES, LLC3 | PO BOX 123042 DALLAS, TX 75312 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $6 | $6 | 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 | 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) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 252 | $1.3M |
| Dental | DELTA DENTAL OF MICHIGAN | 242 | $75K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 252 | $1.3M |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 270 | $75K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 270 | $75K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 270 | $75K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 252 | $1.3M |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 270 | $75K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 270 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.