| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SCOTT SETTLE3 | 2600 W BIG BEAVER RD STE 140 TROY, MI 48084 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $27K | — | $27K | 1.41% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SRVCE LLC STOCKTON CONCORD | 3333 DEPOSIT DR NE STE 230 GRAND RAPIDS, MI 49546 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $15K | $15K | 0.80% |
| KIMBERLY ANN WIXSON3 | 3001 W BIG BEAVER RD STE 320 TROY, MI 48084 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $9K | — | $9K | 0.48% |
| SCOTT SETTLE3 | 2600 W BIG BEAVER RD STE 140 TROY, MI 48084 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $20K | $0 | $20K | 1.24% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 NONE | Direct payment from the plan; Claims processing; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Float revenue; Insurance services; Contract Administrator Service code 12 | — | $964K |
| ANN ARBOR BENEFIT ADMINISTRATORS, I EIN 38-2866123 NONE | Contract Administrator Service code 13 | 3135 S. STATE ST. STE 105 ANN ARBOR, MI 48108 | $373K |
| LAW OFFICE OF THOMAS LUCZAK PLLC EIN 87-3430280 NONE | Legal Service code 29 | 438 S. FIFTH AVE ANN ARBOR, MI 48104 | $291K |
| RBC WEALTH MANAGEMENT NONE | Investment advisory (plan) Service code 27 | 38505 WOODWARD, STE 150 BLOOMFIELD HILLS, MI 48304 | $45K |
| POLK AND ASSOCIATES, P.L.C. EIN 38-3388760 NONE | Accounting (including auditing) Service code 10 | 30600 TELEGRAPH RD 2191 BINGHAM FARMS, MI 48025 | $33K |
| BANK OF ANN ARBOR | Sub-transfer agency fees; Shareholder servicing fees Service code 59 | — | $13K |
| CONLIN, MCKENNEY & PHILBRICK, P.C. NONE | Legal Service code 29 | 350 S. MAIN, STE 400 ANN ARBOR, MI 48104 | $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 | 803 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 300 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,103 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 2,163 | $3.6M |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 795 | $131K |
| Prescription drug(2 contracts) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 320 | $1.7M |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 2,163 | $1.9M |
| Other | DEARBORN LIFE INSURANCE COMPANY | 795 | $131K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,163 | — |
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."
No prospect flags tripped on this filing.