| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KAPNICK & COMPANY, INC.3 | 1201 BRIARWOOD CIR ANN ARBOR, MI 48108 | DELTA DENTAL OF MICHIGAN | $12K | — | $12K | 1.89% |
| KAPNICK & COMPANY, INC.3 | PO BOX 1801 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $9K | $20K | 4.39% |
| BENEFIT COMMUNICATIONS INC3 Filed as: BENEFIT COMMUNICATIONS, INC. | 2977 SIDCO DR NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 4.77% |
| KAPNICK & COMPANY, INC.3 | 333 INDUSTRIAL DRIVE P. O. BOX 1801 ADRIAN, MI 49221 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 2.12% |
| KAPNICK & COMPANY, INC.3 | 333 INDUSTRIAL DRIVE ADRIAN, MI 499218780 | EYEMED VISION CARE | $8K | — | $8K | 9.91% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Direct payment from the plan; Claims processing; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Float revenue; Insurance services; Contract Administrator Service code 12 | — | $563K |
| UNUM LIFE INSURANCE COMPANY OF AMER EIN 01-0278678 | Contract Administrator Service code 13 | — | $15K |
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 | 841 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 19 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 860 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF MICHIGAN | 1,630 | $660K |
| Vision | EYEMED VISION CARE | 1,422 | $78K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 841 | $457K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 841 | $457K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 841 | $541K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,630 | — |
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.