| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES R. HAYES3 | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $28K | $2K | $31K | 3.77% |
| LEGACY PARTNERS II LLC3 Filed as: LEGACY PARTNERS | — | DELTA DENTAL OF MICHIGAN | $8K | — | $8K | 2.99% |
| JAMES R. HAYES3 Filed as: JAMES R HAYES | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $11K | — | $11K | 4.16% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD EIN 38-2069753 NONE | Insurance services; Consulting (general); Contract Administrator; Direct payment from the plan; Claims processing; Other fees; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $299K |
| BENESYS EIN 38-2383171 NONE | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Contract Administrator Service code 12 | — | $90K |
| LEGACY PARTNERS INSURANCE SERVICES NONE | Insurance services; Consulting fees; Direct payment from the plan Service code 23 | 33304 GRAND RIVER FARMINGTON, MI 48336 | $38K |
| WATKINS, PAWLICK, CALATI & PRIFTI NONE | Legal; Direct payment from the plan Service code 29 | 1423 EAST 12 MILE MADSION HEIGHTS, MI 48071 | $16K |
| PNC BANK NONE | Direct payment from the plan; Account maintenance fees Service code 50 | ONE FINACIAL PARKWAY KALAMAZOO, MI 49009 | $12K |
| ELIXIR EIN 05-0570786 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $11K |
| MORGAN STANLEY EIN 13-2655998 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $10K |
| STAFANSKY HOLLOWAY NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | 22260 HAGGERTY ROAD STE 350 NORTHVILLE, MI 481678983 | $7K |
| WRUBEL, WESLEY & CO CPAS EIN 38-2574238 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $7K |
| THE SEGAL COMPANY EIN 06-0939113 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $5K |
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 | 280 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 64 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 344 | 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 | 872 | $256K |
| Life insurance | UNION LABOR LIFE INSURANCE COMPANY | 286 | $32K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 107 | $255K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 315 | $809K |
| Other | UNION LABOR LIFE INSURANCE COMPANY | 286 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 872 | — |
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.