| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JENNIFER RETAMAR3 Filed as: JENNIFER A RETAMAR | 13901 SUTTON PK S B-C S360 JACKSONVILLE, FL 32224 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $70K | — | $70K | 3.00% |
| JON SNEAD3 Filed as: JON D SNEAD | 50 LOUIS STREET NW, SUITE 200 GRAND RAPIDS, MI 49503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $3K | — | $3K | 0.14% |
| KATHERINE C WOOD3 | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 48108 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $3K | — | $3K | 0.12% |
| AON CONSULTING INC3 Filed as: AON RISK SERVICES INC OF FLORIDA | 13901 SUTTON PARK DRIVE, BLDG C SUITE 360 JACKSONVILLE, FL 32224 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $29K | — | $29K | 15.00% |
| AXA ASSISTANCE, USA3 | 122 SOUTH MICHIGAN AVENUE, SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $71 | $71 | 0.04% |
| JENNIFER RETAMAR3 Filed as: JENNIFER A RETAMAR | 13901 SUTTON PARK S B-C S360 JACKSONVILLE, FL 32224 | BLUE CARE NETWORK OF MICHIGAN | $1K | — | $1K | 1.51% |
| JON SNEAD3 Filed as: JON D SNEAD | 50 LOUIS STREET NW, SUITE 200 GRAND RAPIDS, MI 49503 | BLUE CARE NETWORK OF MICHIGAN | $71 | — | $71 | 0.10% |
| AON CONSULTING INC3 Filed as: AON RISK SERVICES, INC. OF FLORIDA | 13901 SUTTON PARK DRIVE, BLDG C SUITE 360 JACKSONVILLE, FL 32224 | HM LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH STREET HAMMONTON, NJ 08037 | CONTINENTAL AMERICAN INSURANCE COMPANY | $7K | — | $7K | 62.51% |
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 | 185 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 189 | 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 | 382 | $2.4M |
| Dental | BLUE CROSS BLUE SHIELD OF MICHIGAN | 382 | $2.3M |
| Vision | HM LIFE INSURANCE COMPANY | 190 | $14K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 212 | $195K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 212 | $195K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 212 | $195K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 382 | $2.4M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 212 | $206K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 382 | — |
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.