| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOSEPH A KING3 Filed as: JOSEPH A. KING | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $13K | $2K | $15K | 3.70% |
| JAMES R. HAYES3 | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $12K | — | $12K | 2.88% |
| TIMBERLAND GROUP SERVICES, INC.3 Filed as: TIMBERLAND GROUP SERVICES INC. | — | DELTA DENTAL OF MICHIGAN | $8K | — | $8K | 2.76% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 NONE | Insurance services; Float revenue; Claims processing; Contract Administrator; Consulting (general); Other fees; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $227K |
| BENESYS INC. EIN 38-2383171 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $70K |
| TIMBERLAND GROUP SERVICES INC. NONE | Insurance services; Direct payment from the plan; Consulting fees Service code 23 | 1707 W. BIG BEAVER ROAD TROY, MI 48084 | $40K |
| SACHS WALDMAN PC EIN 38-1905521 NONE | Legal; Direct payment from the plan Service code 29 | — | $12K |
| ENVISION PHARMACEUTICAL SERVICES EIN 05-0570786 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $10K |
| SCHREIBER ADVISORS PC EIN 46-1282767 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $10K |
| MORGAN STANLEY SMITH BARNEY EIN 13-2655998 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $9K |
| THE SEGAL COMPANY EIN 06-0839113 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $7K |
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 | 255 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 112 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 367 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 117 | $412K |
| Dental | DELTA DENTAL OF MICHIGAN | 842 | $283K |
| Life insurance | UNION LABOR LIFE INSURANCE COMPANY | 249 | $23K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 842 | $413K |
| Other | UNION LABOR LIFE INSURANCE COMPANY | 249 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 842 | — |
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.