| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KARLA SCOTT3 | 11590 N MERIDIAN, STE 600 CARMEL, IN 46032 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $26K | $26K | 5.24% |
| TIC INTERNATIONAL CORPORATION3 Filed as: TIC INTERNATIONAL | 11590 N MERIDIAN, SUITE 600 CARMEL, IN 46032 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $738 | $738 | 0.15% |
| GREGG GOODMAN3 | 11590 N. MERIDIAN, SUITE 600 CARMEL, IN 46032 | BLUE CROSS BLUE SHIELD OF MICHIGAN MEDICARE ADVANTAGE | $5K | — | $5K | 3.04% |
| KARLA SCOTT | 11590 N. MERIDIAN, SUITE 600 CARMEL, IN 46032 | BLUE CROSS BLUE SHIELD OF MICHIGAN MEDICARE ADVANTAGE | $2K | — | $2K | 1.49% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHEILD OF MICHIGAN EIN 38-2069753 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Claims processing; Float revenue; Contract Administrator; Direct payment from the plan; Insurance services; Consulting (general) Service code 12 | — | $496K |
| USI MIDWEST NONE | Direct payment from the plan; Consulting (general) Service code 16 | 222 S. RIVERSIDE PLAZA CHICAGO, IL 60606 | $45K |
| TIC MIDWEST EIN 13-2600875 NONE | Accounting (including auditing); Direct payment from the plan; Contract Administrator; Copying and duplicating; Recordkeeping and information management (computing, tabulating, data processing, etc.); Participant communication; Claims processing Service code 10 | — | $42K |
| DELTA DENTAL OF MICHIGAN EIN 38-1791480 NONE | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $21K |
| BENDA, GRACE, STULZ & COMPANY EIN 38-2284921 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $19K |
| VICTORY CAPITAL MANAGEMENT NONE | Investment management fees paid directly by plan; Investment management Service code 28 | PO BOX 74282 CLEVELAND, OH 441944282 | $14K |
| VARNUM, RIDDERING, SCHMIDT EIN 38-1294924 NONE | Legal; Direct payment from the plan Service code 29 | — | $14K |
| WATKINS ROSS & COMPANY EIN 38-1477362 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $8K |
| YOUSIF CAPITAL MGMT NONE | Investment management fees paid directly by plan; Investment management Service code 28 | 39533 WOODWARD AVE, 100 BLOOMFIELD HILLS, MI 48304 | $8K |
| STANDARD VALUATIONS EIN 41-1327339 NONE | Direct payment from the plan; Consulting (pension) Service code 17 | — | $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 | 452 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 79 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 531 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN MEDICARE ADVANTAGE | 68 | $215K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN MEDICARE ADVANTAGE | 68 | $215K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 529 | $496K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 529 | — |
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.