| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY, INC | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 48108 | DELTA DENTAL OF MICHIGAN | $6K | — | $6K | 7.63% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY, INC | 333 INDUSTRIAL DR ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $2K | $7K | 21.44% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DR ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 21.70% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY, INC | 333 INDUSTRIAL DR ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 21.46% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DR. ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $607 | $2K | 21.13% |
| KAPNICK & COMPANY, INC.3 | 333 INDUSTRIAL DR. ADRIAN, MI 49221 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $216 | $3K | 32.17% |
| W F HILL AND ASSOCIATES INC3 Filed as: WF HILL AND ASSOCIATES INC | 30700 TELEGRAPH RD STE 2620 BINGHAM FARMS, MI 48025 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $936 | $663 | $2K | 16.21% |
| ROBIN W BASIL3 Filed as: ROBIN W. BASIL | 30700 TELEGRAPH RD STE 2620 BINGHAM FARMS, MI 48025 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $394 | $242 | $636 | 6.45% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY, INC | 333 INDUSTRIAL DR ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $479 | $2K | 21.13% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DR ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $277 | $1K | 18.57% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general); Contract Administrator; Direct payment from the plan; Other fees; Claims processing; Insurance services; Float revenue Service code 12 | 600 EAST LAFAYETTE BOULEVARD DETROIT, MI 48226 | $110K |
| KAPNICK AND COMPANY INC. AGENT | Insurance agents and brokers; Non-monetary compensation; Other commissions; Other fees; Insurance brokerage commissions and fees Service code 22 | PO BOX 1801 ADRIAN, MI 49221 | $2K |
| NAILE PALAJ BROKER | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees; Non-monetary compensation; Other fees Service code 22 | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | $1K |
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 | 120 | 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) | 120 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF MICHIGAN | 156 | $80K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 160 | $37K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 56 | $42K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 28 | $18K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 160 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 160 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.