| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST | 222 S RIVERSIDE PLAZA, SUITE 630 CHICAGO, IL 60606 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $14K | $14K | 2.62% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHEILD OF MICHIGAN EIN 38-2069753 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Insurance services; Float revenue; Other fees; Claims processing; Direct payment from the plan; Contract Administrator; Consulting (general) Service code 12 | — | $431K |
| USI MIDWEST NONE | Direct payment from the plan; Consulting (general) Service code 16 | 222 S. RIVERSIDE PLAZA CHICAGO, IL 60606 | $93K |
| TIC INTERNATIONAL CORPORATION EIN 13-2600875 NONE | Participant communication; Accounting (including auditing); Contract Administrator; Claims processing; Copying and duplicating; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 10 | — | $61K |
| VARNUM, RIDDERING, SCHMIDT EIN 38-1294924 NONE | Legal; Direct payment from the plan Service code 29 | — | $25K |
| MUNDER CAPITAL EIN 38-3212521 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $17K |
| BENDA, GRACE, STULZ & COMPANY PC EIN 38-2284921 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $15K |
| WATKINS ROSS NONE | Actuarial; Direct payment from the plan Service code 11 | 200 OTTAWA AVE NW STE 600 GRAND RAPIDS, MI 49503 | $7K |
| KEYBANK NATIONAL ASSOCIATION NONE | Direct payment from the plan; Investment management Service code 28 | 127 PUBLIC SQUARE 17TH FL CLEVELAND, OH 44114 | $6K |
| GREGG M GOODMAN NONE | Other fees; Non-monetary compensation; Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 11590 N MERIDAN SUITE 600 CARMEL, IN 46032 | $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 | 402 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 182 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 584 | 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 | 64 | $385K |
| Dental | DELTA DENTAL OF MICHIGAN | 1,390 | $381K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN MEDICARE ADVANTAGE | 64 | $385K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 497 | $525K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,390 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.