| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | KELLEY DEMIRYAN TROY, MI 48083 | DELTA DENTAL OF MICHIGAN | $5K | — | $5K | 2.82% |
| KELLEY A. DEMIRYAN3 | 30150 TELEGRAPH RD STE 408 BINGHAM FARMS, MI 48025 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $5K | $15K | $20K | 14.47% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 30150 TELEGRAPH RD STE 408 BINGHAM FARMS, MI 48025 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $1K | $1K | 0.93% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 30150 TELEGRAPH RD STE 408 BINGHAM FARMS, MI 48025 | SYMETRA LIFE INSURANCE COMPANY | $12K | — | $12K | 8.97% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J GALLAGHER & CO | 2850 GOLF RD 5TH FLR ROLLING MEADOWS, IL 60008 | SYMETRA LIFE INSURANCE COMPANY | — | $4K | $4K | 3.17% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES OF | MICHIGAN, INC. 2850 GOLF RD STE 1000 ROLLING MEADOWS, IL 600084036 | VISION SERVICE PLAN | $1K | — | $1K | 5.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHER J GALLAGHER & CO | 2850 GOLF RD 5TH FLR ROLLING MEADOWS, IL 60008 | SYMETRA LIFE INSURANCE COMPANY | — | $4 | $4 | 0.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CARE NETWORK EIN 38-2359234 NONE | Contract Administrator Service code 13 | — | $365K |
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 NONE | Consulting (general); Insurance services; Float revenue; Other fees; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator Service code 12 | — | $90K |
| EMPLOYEE HEALTH INSURANCE MGMT, INC EIN 38-2776173 NONE | Claims processing; Insurance brokerage commissions and fees Service code 12 | — | $13K |
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 | 301 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 305 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF MICHIGAN | 547 | $168K |
| Vision | VISION SERVICE PLAN | 243 | $23K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 306 | $133K |
| Short-term disability | SYMETRA LIFE INSURANCE COMPANY | 306 | $133K |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 306 | $133K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 96 | $138K |
| Other(2 contracts) | SYMETRA LIFE INSURANCE COMPANY | 306 | $151K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 547 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.