| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MICHAEL C WALKER3 Filed as: MICHAEL G. BUCK | 38221 MOUND ROAD STERLING HEIGHTS, MI 48310 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $26K | — | $26K | 3.86% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 NONE | Claims processing; Float revenue; Insurance services; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Direct payment from the plan; Contract Administrator Service code 12 | 27000 W 11 MILE RD SOUTHFIELD, MI 48034 | $725K |
| BENEFIT ADVISORS, INC EIN 38-3558012 NONE | Accounting (including auditing); Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Participant communication; Contract Administrator; Recordkeeping fees; Direct payment from the plan Service code 10 | 24900 HARPER AVE ST CLAIR SHORES, MI 48080 | $212K |
| FERGUSON WIDMAYER PC EIN 38-2995783 NONE | Direct payment from the plan; Legal Service code 29 | 538 N DIVISION ANN ARBOR, MI 48104 | $88K |
| ASSOCIATION BENEFITS, INC EIN 38-3000355 NONE | Consulting (general); Insurance agents and brokers; Insurance brokerage commissions and fees Service code 16 | 26555 EVERGREEN ROAD, SUITE 410 SOUTHFIELD, MI 48076 | $63K |
| DELTA DENTAL EIN 38-1791480 NONE | Claims processing; Trustee (discretionary); Direct payment from the plan Service code 12 | PO BOX 790014 DETROIT, MI 48279 | $57K |
| O'SULLIVAN ASSOCIATES, INC EIN 20-8199367 NONE | Direct payment from the plan; Actuarial Service code 11 | 1236 BRACE RD UNIT E CHERRY HILL, NJ 08034 | $26K |
| BENNETT & ASSOCIATES CPAS PLLC EIN 27-3488128 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | 100 HURONVIEW BLVD, SUITE 200 ANN ARBOR, MI 48103 | $19K |
| COMERICA BANK EIN 42-1741646 NONE | Direct payment from the plan; Custodial (securities) Service code 19 | 411 W LAFAYETTE DETROIT, MI 48226 | $7K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 270 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 80 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 350 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 350 | $662K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 350 | — |
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.