| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES R. HAYES3 | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $20K | — | $20K | 3.46% |
| JOSEPH A KING3 Filed as: JOSEPH A. KING | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $3K | — | $3K | 0.55% |
| JAMES R. HAYES3 | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $6K | — | $6K | 1.24% |
| THOMAS W BOSTON3 Filed as: THOMAS REUTER | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $6K | — | $6K | 1.24% |
| LEGACY PARTNERS II LLC3 | — | DELTA DENTAL OF MICHIGAN | $9K | — | $9K | 3.26% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD EIN 38-2069753 NONE | Direct payment from the plan; Other fees; Contract Administrator; Claims processing; Float revenue; Insurance services; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $265K |
| BENESYS EIN 38-2383171 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing; Copying and duplicating; Participant communication; Direct payment from the plan; Contract Administrator Service code 12 | — | $83K |
| LEGACY PARTNERS INSURANCE SERVICES NONE | Direct payment from the plan; Consulting fees; Insurance services Service code 23 | 33304 GRAND RIVER FARMINGTON, MI 48336 | $44K |
| THE SEGAL COMPANY EIN 06-0839113 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $16K |
| PNC BANK NONE | Account maintenance fees; Direct payment from the plan Service code 50 | ONE FINACIAL PARKWAY KALAMAZOO, MI 49009 | $16K |
| ENVISION PHARMACEUTICAL SERVICES EIN 05-0570786 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $12K |
| MORGAN SMITH BARNEY EIN 13-2655998 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $10K |
| SACHS WALDMAN PC EIN 38-1905521 NONE | Legal; Direct payment from the plan Service code 29 | — | $9K |
| WRUBEL WESLEY AND COMPANY C.P.A.'S EIN 38-2754238 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $6K |
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 | 279 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 103 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 382 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 114 | $461K |
| Dental | DELTA DENTAL OF MICHIGAN | 909 | $288K |
| Life insurance | UNION LABOR LIFE INSURANCE COMPANY | 268 | $27K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 840 | $587K |
| Other | UNION LABOR LIFE INSURANCE COMPANY | 268 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 909 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.