| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES Filed as: WELLS FARGO INSURANCE SERVICES USA | 4000 TOWN CENTER SUITE 800 SOUTHFIELD, MI 48075 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $73K | $3 | $73K | 1.62% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 4000 TOWN CENTER SUITE 800 SOUTHFIELD, MI 48075 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $2K | $2K | 0.04% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 4000 TOWN CENTER SUITE 800 SOUTHFIELD, MI 48075 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $6K | $6K | 1.76% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | PO BOX 203318 DALLAS, TX 75320 | VISION SERVICE PLAN | $1K | $0 | $1K | 1.88% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 4000 TOWN CENTER SUITE 800 SOUTHFIELD, MI 48075 | VISION SERVICE PLAN | $860 | $0 | $860 | 1.33% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 4000 TOWN CENTER SUITE 800 SOUTHFIELD, MI 48075 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | $0 | $4K | 16.94% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | PO BOX 203318 DALLAS, TX 75320 | HYATT LEGAL PLANS | $2K | $0 | $2K | 10.04% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 1018 WEST 9TH AVENUE KING OF PRUSSIA, PA 19406 | HYATT LEGAL PLANS | $0 | $112 | $112 | 0.56% |
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 | 1,080 | 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) | 1,080 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 748 | $4.5M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 513 | $402K |
| Vision | VISION SERVICE PLAN | 446 | $65K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,080 | $364K |
| Short-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,080 | $364K |
| Long-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,080 | $364K |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,080 | $384K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,080 | — |
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.