| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACTION BENEFITS COMPANY3 | 25800 NORTHWESTERN HIGHWAY SUITE 600 SOUTHFIELD, MI 48075 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $9K | $0 | $9K | 1.08% |
| BENNIE INSURANCE, LLC3 | 1209 ORANGE STREET WILMINGTON, MI 19801 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $545 | $545 | 0.07% |
| GREGORY AUTUORI3 | 195 BROADWAY, 15TH FLOOR NEW YORK, NY 10007 | BLUE CARE NETWORK OF MICHIGAN | $5K | $0 | $5K | 3.00% |
| ACTION BENEFITS COMPANY3 | 25800 NORTHWESTERN HIGHWAY SUITE 600 SOUTHFIELD, MI 48075 | BLUE CARE NETWORK OF MICHIGAN | $2K | $0 | $2K | 0.97% |
| PROFESSIONAL GROUP PLANS INC3 Filed as: PROFESSIONAL GROUP PLANS, INC. | 225 WIRELESS BOULEVARD, 2ND FLOOR HAUPPAUGE, NY 11788 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $4K | $4K | 5.00% |
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 | 114 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 41 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 155 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 205 | $984K |
| Dental | DELTA DENTAL OF MICHIGAN | 250 | $85K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 205 | $984K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 145 | $86K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 145 | $86K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 145 | $86K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 205 | $984K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 145 | $86K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 250 | — |
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.