| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SAGINAW BAY UNDERWRITERS3 | 1258 S WASHINGTON SAGINAW, MI 48601 | EXPRESS SCRIPTS INC | $70K | — | $70K | 4.25% |
| SAGINAW BAY UNDERWRITERS3 | 1213 SOUTH WASHINGTON SAGINAW, MI 48605 | HARTFORD LIFE AND ACCIDENT | $56K | $3K | $58K | 5.83% |
| ASR HEALTH BENEFITS3 | — | ARDELLIS | $27K | — | $27K | 3.50% |
| SAGINAW BAY UNDERWRITERS3 | PO BOX 1928 SAGINAW, MI 48605 | DELTA DENTAL OF MICHIGAN | $9K | — | $9K | 2.14% |
| SAGINAW BAY UNDERWRITERS3 | 1258 S WASHINGTON SAGINAW, MI 48601 | VISION SERVICE PLAN | $2K | — | $2K | 6.76% |
| SAGINAW BAY UNDERWRITERS3 | 1258 S WASHINGTON SAGINAW, MI 48601 | HARTFORD LIFE AND ACCIDENT | $453 | $9 | $462 | 15.28% |
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 | 1,058 | 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) | 1,058 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXPRESS SCRIPTS INC | 269 | $1.6M |
| Dental | DELTA DENTAL OF MICHIGAN | 1,637 | $437K |
| Vision | VISION SERVICE PLAN | 154 | $25K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 1,058 | $1.0M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 1,058 | $1.0M |
| Stop-loss / reinsurancereinsurance | ARDELLIS | 705 | $767K |
| Other(2 contracts) | HARTFORD LIFE AND ACCIDENT | 1,058 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,637 | — |
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.