| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMY J HALL3 Filed as: AMY HALL | 423 NORTH MAIN STREET ROYAL OAK, MI 48067 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $21K | $0 | $21K | 3.85% |
| ASSUREDPARTNERS3 | 13900 LAKESIDE CIRCLE STERLING HEOGHTS, MI 48313 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $2K | $2K | 0.29% |
| JOEL CLARK3 | 25900 WEST 11 MILE ROAD SUITE 210 SOUTHFIELD, MI 48034 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $1K | $0 | $1K | 0.21% |
| AMY J HALL3 Filed as: AMY HALL | 423 NORTH MAIN STREET ROYAL OAK, MI 48067 | BLUE CARE NETWORK OF MICHIGAN | $16K | $0 | $16K | 2.97% |
| ASSUREDPARTNERS3 | 13900 LAKESIDE CIRCLE STERLING HEIGHTS, MI 48313 | BLUE CARE NETWORK OF MICHIGAN | $0 | $751 | $751 | 0.14% |
| ASSUREDPARTNERS3 | 25900 WEST 11 MILE ROAD SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $0 | $6K | 11.99% |
| ASSUREDPARTNERS3 | 25900 WEST 11 MILE ROAD SUITE 210 SOUTHFIELD, MI 48034 | UNUM INSURANCE COMPANY | $3K | $190 | $4K | 23.69% |
| ASSUREDPARTNERS3 | 27064 OAKMEAD DRIVE PERRYSBURG, OH 43551 | UNUM INSURANCE COMPANY | $3K | $0 | $3K | 22.42% |
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 | 117 | 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) | 117 | 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 | 219 | $1.1M |
| Dental | BLUE CROSS BLUE SHIELD OF MICHIGAN | 219 | $558K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 219 | $558K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 117 | $50K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 117 | $50K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 219 | $1.1M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 117 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 219 | — |
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.