| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES R. HAYES3 | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $28K | $2K | $30K | 3.73% |
| JAMES R. HAYES3 Filed as: JAMES R HAYES | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $11K | $0 | $11K | 4.16% |
| LEGACY PARTNERS II LLC3 | — | DELTA DENTAL OF MICHIGAN | $8K | — | $8K | 3.28% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD EIN 38-2069753 NONE | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general); Insurance services; Direct payment from the plan; Claims processing; Other fees; Float revenue Service code 12 | — | $286K |
| BENESYS EIN 38-2383171 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Direct payment from the plan; Claims processing Service code 12 | — | $88K |
| LEGACY PARTNERS INSURANCE SERVICES NONE | Insurance services; Consulting fees; Direct payment from the plan Service code 23 | 33304 GRAND RIVER FARMINGTON, MI 48336 | $38K |
| ELIXIR EIN 05-0570786 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $21K |
| WATKINS, PAWLICK, CALATI, & PRIFTI NONE | Legal; Direct payment from the plan Service code 29 | 1423 EAST 12 MILE ROAD MADISON HEIGHTS, MI 48071 | $15K |
| THE SEGAL COMPANY EIN 06-0839113 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $13K |
| PNC BANK NONE | Direct payment from the plan; Account maintenance fees Service code 50 | ONE FINANCIAL PARKWAY KALAMAZOO, MI 49009 | $12K |
| MORGAN STANLEY SMITH BARNEY EIN 13-2655998 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $10K |
| DELTA DENTAL OF MICHIGAN EIN 38-1791480 NONE | Direct payment from the plan; Claims processing; Contract Administrator Service code 12 | — | $9K |
| WRUBEL, WESLEY & CO CPAS EIN 38-2574238 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $7K |
| AMERICAN GRAPHICS NONE | Copying and duplicating; Direct payment from the plan Service code 36 | 34895 GROESBECK HIGHWAY CLINTON TOWNSHIP, MI 48035 | $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 | 277 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 74 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 351 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 107 | $255K |
| Dental | DELTA DENTAL OF MICHIGAN | 313 | $241K |
| Life insurance | UNION LABOR LIFE INSURANCE COMPANY | 286 | $32K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 313 | $811K |
| Other | UNION LABOR LIFE INSURANCE COMPANY | 286 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 313 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.