| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE INC | 2850 GOLF RD STE 1000 ROLLING MEADOWS, IL 60008 | TOTAL HEALTH CARE USA, INC. | $13K | — | $13K | 3.11% |
| KELLEY A. DEMIRYAN3 | GALLAGHER BENEFIT SRVCS 30150 TELEGRAPH RD STE 408 BINGHAM FARMS, MI 48025 | BLUE CROSS AND BLUE SHIELD OF MICHIGAN | $925 | — | $925 | 1.70% |
| MICHAEL KYLE3 Filed as: MICHAEL SEAN KYLE | PAYCHEX INSURANCE AGY INC 29065 CABOT DR STE 100 NOVI, MI 48377 | BLUE CROSS AND BLUE SHIELD OF MICHIGAN | $131 | — | $131 | 0.24% |
| PAYCHEX INSURANCE AGENCY, INC.3 | PO BOX 948 ROCHESTER, NY 14620 | DELTA DENTAL OF MICHIGAN | $3K | $133 | $3K | 6.45% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 30150 TELEGRAPH RD TROY, MI 48083 | DELTA DENTAL OF MICHIGAN | $2K | $133 | $2K | 4.24% |
| PAYCHECK INSURANCE AGENCY, INC.3 Filed as: PAYCHECK INSURANCE AGENCY INC | 225 KENNETH DR ROCHESTER, NY 14623 | NIPPON LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 3.78% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 30150 TELEGRAPH RD BINGHAM FARMS, MI 48025 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INSURANCE C | $610 | — | $610 | 7.03% |
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 | 111 | 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) | 111 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | TOTAL HEALTH CARE USA, INC. | 138 | $467K |
| Dental | DELTA DENTAL OF MICHIGAN | 171 | $46K |
| Vision(2 contracts, 2 carriers) | TOTAL HEALTH CARE USA, INC. | 163 | $421K |
| Life insurance | NIPPON LIFE INSURANCE COMPANY OF AMERICA | 111 | $27K |
| Short-term disability | NIPPON LIFE INSURANCE COMPANY OF AMERICA | 111 | $27K |
| Prescription drug | TOTAL HEALTH CARE USA, INC. | 138 | $412K |
| Other | NIPPON LIFE INSURANCE COMPANY OF AMERICA | 111 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 171 | — |
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.