| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EMPLOYEE NAVIGATOR, LLC3 Filed as: EMPLOYEE BENEFITS AGENCY | PO BOX 747 MARQUETTE, MI 49855 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $5K | $5K | 2.85% |
| VINCENT J. ROSE3 Filed as: VINCENT J, ROSE | PO BOX 747 MARQUETTE, MI 49855 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $4K | — | $4K | 2.04% |
| MICHAEL C WALKER3 Filed as: MICHAEL G. BUCK | 26555 EVERGREEN ROAD, SUITE 410 SOUTHFIELD, MI 48076 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $3K | — | $3K | 1.74% |
| ASSOCIATION BENEFITS CO3 Filed as: ASSOCIATION BENEFITS COMPANY | 26555 EVERGREEN ROAD, SUITE 410 SOUTHFIELD, MI 48076 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $597 | $597 | 0.31% |
| VINCENT J. ROSE3 Filed as: VINCENT ROSE | PO BOX 747 MARQUETTE, MI 49855 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $2K | — | $2K | 1.71% |
| MICHAEL BUCK3 | 26555 EVERGREEN ROAD, SUITE 410 SOUTHFIELD, MI 48076 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $2K | — | $2K | 1.71% |
| ASSOCIATION BENEFITS CO3 Filed as: ASSOCIATION BENEFITS COMPANY | 26555 EVERGREEN ROAD SOUTHFIELD, MI 48076 | DELTA DENTAL OF MICHIGAN | $1K | — | $1K | 1.42% |
| ADVANCED BENEFIT SOLUTIONS INC3 Filed as: ADVANCED BENEFIT SOLUTIONS, INC. | PO BOX 700 CADILLAC, MI 49601 | DELTA DENTAL OF MICHIGAN | $1K | — | $1K | 1.08% |
| EMPLOYEE NAVIGATOR, LLC3 Filed as: EMPLOYEE BENEFITS AGENCY, INC. | PO BOX 747 MARQUETTE, MI 49855 | DELTA DENTAL OF MICHIGAN | $457 | — | $457 | 0.47% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 NONE | Other fees; Float revenue; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Insurance services; Contract Administrator; Claims processing Service code 12 | — | $212K |
| TIC INTERNATIONAL CORPORATION EIN 13-2600875 NONE | Participant communication; Claims processing; Copying and duplicating; Recordkeeping and information management (computing, tabulating, data processing, etc.); Accounting (including auditing); Plan Administrator; Direct payment from the plan; Consulting (general) Service code 10 | — | $146K |
| NOVARA TESIJA, PLLC EIN 38-2823147 NONE | Legal; Direct payment from the plan Service code 29 | — | $75K |
| MICHAEL G. BUCK NONE | Insurance agents and brokers; Non-monetary compensation; Insurance brokerage commissions and fees; Other commissions Service code 22 | 26555 EVERGREEN, STE 410 SOUTHFIELD, MI 48076 | $17K |
| VINCENT J. ROSE NONE | Other commissions; Non-monetary compensation; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | PO BOX 747 MARQUETTE, MI 49855 | $17K |
| BENDA, GRACE, STULZ & COMPANY, P.C. EIN 38-2284921 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $14K |
| UNITED ACTUARIAL SERVICES EIN 35-2156428 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $9K |
| MARQUETTE ASSOCIATES EIN 36-3485298 NONE | Investment management; Direct payment from the plan Service code 28 | — | $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 | 257 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 42 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 299 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 20 | $110K |
| Dental | DELTA DENTAL OF MICHIGAN | 687 | $98K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 20 | $110K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 288 | $192K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 687 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.