| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES R. HAYES3 | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $22K | — | $22K | 3.47% |
| JAMES R. HAYES3 | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $11K | — | $11K | 2.98% |
| EA LEGACY LLC3 Filed as: LEGACY PARTNERS II, LLC-JAMES HAYES | — | DELTA DENTAL OF MICHIGAN | $7K | — | $7K | 2.73% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD EIN 38-2069753 NONE | Float revenue; Other fees; Direct payment from the plan; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general); Insurance services; Claims processing Service code 12 | — | $284K |
| BENESYS EIN 38-2383171 NONE | Copying and duplicating; Claims processing; Direct payment from the plan; Participant communication; Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Accounting (including auditing) Service code 10 | — | $86K |
| LEGACY PARTNERS INSURANCE SERVICES NONE | Insurance services; Direct payment from the plan; Consulting fees Service code 23 | 33304 GRAND RIVER FARMINGTON, MI 48336 | $43K |
| PNC BANK NONE | Direct payment from the plan; Account maintenance fees Service code 50 | ONE FINANCIAL PARKWAY KALAMAZOO, MI 49009 | $14K |
| ENVISION PHARMACEUTICAL SERVICES EIN 05-0570786 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $11K |
| MORGAN STANLEY EIN 13-2655998 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $10K |
| THE SEGAL COMPANY EIN 06-0839113 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $7K |
| WATKINS, PAWLICK, CALATI & PRIFTI P NONE | Legal; Direct payment from the plan Service code 29 | 1423 EAST 12 MILE ROAD MADISON HEIGHTS, MI 48071 | $7K |
| WRUBEL WESLEY AND COMPANY CPA'S EIN 38-2574238 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 | 287 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 106 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 393 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 107 | $358K |
| Dental | DELTA DENTAL OF MICHIGAN | 936 | $256K |
| Life insurance | UNION LABOR LIFE INSURANCE COMPANY | 263 | $28K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 382 | $636K |
| Other | UNION LABOR LIFE INSURANCE COMPANY | 263 | $28K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 936 | — |
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."
No prospect flags tripped on this filing.