| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LISA BOURDAGE3 | 4000 TOWN CTR STE 800 SOUTHFIELD, MI 480751405 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $27K | — | $27K | 3.50% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SRVCE LLC STOCKTON CONCORD | 100 SUMMIT LAKE DRIVE SUITE 400 VALHALLA, NY 10595 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $6K | $6K | 0.74% |
| 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 | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 NONE | Claims processing; Other fees; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Direct payment from the plan; Contract Administrator; Insurance services Service code 12 | — | $672K |
| ANN ARBOR BENEFIT ADMINISTRATORS EIN 38-2866123 NONE | Contract Administrator Service code 13 | — | $295K |
| CONLIN, MCKENNEY & PHILBRICK EIN 38-2772489 NONE | Legal Service code 29 | — | $186K |
| RBC WEALTH MANAGEMENT NONE | Investment advisory (plan) Service code 27 | 38505 WOODWARD, STE 150 248-336-5106 BLOOMFIELD HILLS, MI 483049904 | $45K |
| BANK OF ANN ARBOR EIN 38-3252110 NONE | Trustee (directed) Service code 25 | — | $37K |
| LISA BOURDAGE NONE | Non-monetary compensation; Other fees; Insurance agents and brokers; Other commissions; Insurance brokerage commissions and fees Service code 22 | 4000 TOWN CTR STE 800 SOUTHFIELD, MI 48075 | $27K |
| POLK AND ASSOCIATES, P.L.C. EIN 38-3388760 NONE | Accounting (including auditing) Service code 10 | — | $27K |
| THE SEGAL COMPANY EIN 13-1975125 NONE | Actuarial Service code 11 | — | $26K |
| USI INS SRVCE LLC STOCKTON CONCORD NONE | Insurance agents and brokers; Other fees; Other commissions; Non-monetary compensation; Insurance brokerage commissions and fees Service code 22 | 100 SUMMIT LAKE STE 400 VALHALLA, NY 10595 | $6K |
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 | 639 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 320 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 959 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,866 | $2.2M |
| Life insurance | DEARBORN NATIONAL | 630 | $94K |
| Prescription drug(2 contracts) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 302 | $1.4M |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 1,866 | $785K |
| Other | DEARBORN NATIONAL | 630 | $94K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,866 | — |
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.