| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRICIA SULLIVAN FORLETTA3 | 30150 TELEGRAPH ROAD, SUITE 408 BINGHAM FARMS, MI 48025 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $35K | $0 | $35K | 1.98% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 30150 TELEGRAPH ROAD, SUITE 408 BINGHAM FARMS, MI 48025 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $3K | $3K | 0.19% |
| EDWARD PURCELL3 | 1301 EAST 9TH STREET, SUITE 3737 CLEVELAND, OH 44114 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $888 | $888 | 0.05% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2800 LIVERNOIS ROAD, SUITE 275 TROY, MI 48083 | DELTA DENTAL OF MICHIGAN | $8K | — | $8K | 8.37% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | DELTA DENTAL OF MICHIGAN | $776 | — | $776 | 0.82% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | METROPOLITAN LIFE INSURANCE COMPANY | $7K | $41 | $7K | 9.73% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $946 | $4K | 6.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $1K | $1K | 1.59% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 906 WEST 2ND AVENUE, SUITE 400 SPOKANE, WA 99201 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $41 | $41 | 0.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 1111 SUPERIOR AVENUE EAST SUITE 1601 CLEVELAND, OH 44114 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $9 | $9 | 0.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 30150 TELEGRAPH ROAD, SUITE 408 BINGHAM FARMS, MI 48025 | VISION SERVICE PLAN | $2K | $0 | $2K | 6.68% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | VISION SERVICE PLAN | $286 | $0 | $286 | 0.91% |
No Schedule C service providers reported on this filing.
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 | 110 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 247 | $1.8M |
| Dental | DELTA DENTAL OF MICHIGAN | 246 | $94K |
| Vision | VISION SERVICE PLAN | 186 | $32K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 215 | $69K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 215 | $69K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 215 | $69K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 247 | $1.8M |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 215 | $69K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 247 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.