| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GREGG GOODMAN3 Filed as: GREGG M. GOODMAN | 11590 N MERIDIAN, SUITE 600 CARMEL, IN 46032 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $19K | — | $19K | 3.50% |
| GREGG GOODMAN3 | 11590 N. MERIDIAN, SUITE 600 CARMEL, IN 46032 | BLUE CROSS BLUE SHIELD OF MICHIGAN MEDICARE ADVANTAGE | — | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHEILD OF MICHIGAN EIN 38-2069753 NONE | Contract Administrator; Consulting (general); Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Insurance services; Float revenue; Other fees Service code 12 | — | $455K |
| 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 | — | $69K |
| USI MIDWEST NONE | Consulting (general); Direct payment from the plan Service code 16 | 222 S. RIVERSIDE PLAZA CHICAGO, IL 60606 | $45K |
| VICTORY CAPITAL MANAGEMENT NONE | Investment management fees paid directly by plan; Investment management Service code 28 | P.O. BOX 74282 CLEVENLAND, OH 441944282 | $30K |
| DELTA DENTAL OF MICHIGAN EIN 38-1791480 NONE | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $25K |
| GREGG M GOODMAN NONE | Insurance brokerage commissions and fees; Other fees; Insurance agents and brokers; Non-monetary compensation; Other commissions Service code 22 | 11590 N MERIDIAN SUITE 60 CARMEL, IN 46032 | $19K |
| BENDA, GRACE, STULZ & COMPANY PC EIN 38-2284921 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $17K |
| VARNUM, RIDDERING, SCHMIDT EIN 38-1294924 NONE | Legal; Direct payment from the plan Service code 29 | — | $17K |
| KEY BANK NATIONAL ASSOCIATION NONE | Investment management fees paid directly by plan; Investment management Service code 28 | 100 PUBLIC SQUARE CLEVELAND, OH 44113 | $8K |
| WATKINGS ROSS & COMPANY EIN 38-1477362 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $8K |
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 | 488 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 83 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 571 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 64 | $0 |
| Prescription drug(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 64 | $0 |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 517 | $544K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 517 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.