| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOSEPH J HANEY3 Filed as: JOSEPH J. HANEY | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $55K | — | $55K | 4.75% |
| JAMES R. HAYES3 | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $15K | — | $15K | 1.30% |
| LEGACY PARTNERS II LLC3 | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $2K | $2K | 0.16% |
| JAMES R. HAYES3 | — | BLUE CROSS BLUE SHIELD OF MICHIGAN | $9K | — | $9K | 2.03% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF MICHIGAN | — | DELTA DENTAL OF MICHIGAN | $8K | — | $8K | 2.97% |
| 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; Float revenue; Claims processing; Other fees; Direct payment from the plan Service code 12 | — | $394K |
| BENESYS EIN 38-2383171 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $96K |
| LEGACY PARTNERS INSURANCE SERVICES NONE | Consulting fees; Direct payment from the plan; Insurance services Service code 23 | 33304 GRAND RIVER FARMINGTON, MI 48336 | $37K |
| WATKINS, PAWLICK, CALATI & PRIFTI P NONE | Legal; Direct payment from the plan Service code 29 | 1423 EAST 12 MILE MADISON HEIGHTS, MI 48071 | $29K |
| AMERICAN GRAPHICS PRINTING NONE | Direct payment from the plan; Other services Service code 49 | 34895 GROESBECK HIGHWAY CLINTON TOWNSHIP, MI 48035 | $17K |
| PNC BANK NONE | Account maintenance fees; Direct payment from the plan Service code 50 | ONE FINANCIAL PARKWAY KALAMAZOO, MI 49009 | $13K |
| THE SEGAL COMPANY EIN 06-0839113 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $10K |
| MORGAN STANLEY SMITH BARNEY EIN 13-2655998 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $10K |
| WRUBEL WESLEY AND COMPANY C.P.A.'S EIN 38-2574238 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $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 | 299 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 63 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 362 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 95 | $424K |
| Dental | DELTA DENTAL OF MICHIGAN | 880 | $257K |
| Life insurance | UNION LABOR LIFE INSURANCE COMPANY | 294 | $30K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 95 | $424K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 300 | $1.2M |
| Other | UNION LABOR LIFE INSURANCE COMPANY | 294 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 880 | — |
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.