| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF FLORIDA5 Filed as: BLUE CROSS BLUE SHIELD OF MICHIGAN | 27000 W. 11 MILE RD SOUTHFIELD, MI 480342200 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $477K | $477K | 131.88% |
| GREGG PRANGER3 | 4000 TOWN CTR STE 800 SOUTHFIELD, MI 480751405 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $12K | — | $12K | 3.32% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SRVCS USA INC | 4000 TOWN CTR STE 800 SOUTHFIELD, MI 480751405 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $6K | $6K | 1.77% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 NONE | Contract Administrator; Direct payment from the plan; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Float revenue; Insurance services; Consulting (general) Service code 12 | — | $477K |
| ANN ARBOR BENEFIT ADMINISTRATORS EIN 38-2866123 NONE | Contract Administrator Service code 13 | — | $247K |
| CONLIN, MCKENNEY & PHILBRICK EIN 38-2772489 NONE | Legal Service code 29 | — | $168K |
| BANK OF ANN ARBOR EIN 38-3252110 NONE | Trustee (directed) Service code 25 | — | $31K |
| BZ BLOOM, LTD EIN 51-5212298 NONE | Other services; Investment management fees paid directly by plan Service code 49 | — | $31K |
| THE SEGAL COMPANY EIN 13-1975125 NONE | Actuarial Service code 11 | — | $22K |
| WELLS FARGO ADVISORS EIN 34-1542819 NONE | Investment advisory (plan) Service code 27 | — | $20K |
| ROGOW & LONEY,PC EIN 38-2971941 NONE | Accounting (including auditing) Service code 10 | — | $18K |
| GREGG PRANGER NONE | Insurance agents and brokers; Other fees; Other commissions; Insurance brokerage commissions and fees; Non-monetary compensation Service code 22 | 4000 TOWN CTR, STE 800 SOUTHFIELD, MI 48075 | $12K |
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 | 583 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 285 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 868 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,698 | $2.0M |
| Life insurance | DEARBORN NATIONAL | 591 | $78K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 285 | $1.6M |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,698 | $362K |
| Other | DEARBORN NATIONAL | 591 | $78K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,698 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.