| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GREGG PRANGER3 | 4000 TOWN CENTER, SUITE 800 SOUTHFIELD, MI 48075 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $52K | — | $52K | 1.49% |
| WELLS FARGO INSURANCE SERVICES3 | 4000 TOWN CENTER, SUITE 800 SOUTHFIELD, MI 48075 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $1K | $1K | 0.04% |
| WELLS FARGO INSURANCE SERVICES3 | 4000 TOWN CENTER, SUITE 800 SOUTHFIELD, MI 48075 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $3K | $3K | 0.87% |
| WELLS FARGO INSURANCE SERVICES3 | 4000 TOWN CENTER, SUITE 800 SOUTHFIELD, MI 48075 | VISION SERVICE PLAN | $1K | — | $1K | 2.00% |
| WELLS FARGO INSURANCE SERVICES3 | 600 HIGHWAY 169 SOUTH, SUITE 1200 SAINT LOUIS PARK, MN 55426 | VISION SERVICE PLAN | $863 | — | $863 | 1.71% |
| WELLS FARGO INSURANCE SERVICES3 | 401 SOUTH TRYON STREET, 27TH FLOOR CHARLOTTE, NC 28202 | HYATT LEGAL PLANS | $2K | — | $2K | 9.27% |
| WELLS FARGO INSURANCE SERVICES3 | 64 MONROE AVENUE NW, SUITE 300 GRAND RAPIDS, MI 49503 | HYATT LEGAL PLANS | — | $202 | $202 | 1.05% |
| WELLS FARGO INSURANCE SERVICES3 | 11017 COBBLEROCK DRIVE, SUITE 100 RANCHO CORDOVA, CA 95670 | HYATT LEGAL PLANS | — | $137 | $137 | 0.71% |
| WELLS FARGO INSURANCE SERVICES3 | 1018 WEST 9TH AVENUE KING OF PRUSSIA, PA 19406 | HYATT LEGAL PLANS | — | $27 | $27 | 0.14% |
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 | 1,053 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 15 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,068 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 611 | $3.5M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 409 | $340K |
| Vision | VISION SERVICE PLAN | 328 | $50K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,053 | $300K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,053 | $300K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,053 | $300K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 611 | $3.5M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,053 | $319K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,053 | — |
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.