| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ELIZABETH MADZIAR3 | 1201 BRIARWOOD CIR ANN ARBOR, MI 48108 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $28K | — | $28K | 3.36% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK AND COMPANY, INC. | PO BOX 1801 ADRIAN, MI 49221 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $2K | $2K | 0.23% |
| ACTION BENEFITS COMPANY3 | 25800 NORTHWESTERN HIGHWAY SUITE 6 SOUTHFIELD, MI 480758075 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $104 | — | $104 | 0.01% |
| ELIZABETH MADZIAR3 | 1201 BRIARWOOD CIRCLE ANN ARBOR, MI 48108 | BLUE CARE NETWORK OF MICHIGAN | $12K | — | $12K | 3.20% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | PO BOX 1801 ADRIAN, MI 492219221 | BLUE CARE NETWORK OF MICHIGAN | — | $768 | $768 | 0.20% |
| ACTION BENEFITS COMPANY3 | 25800 NORTHWESTERN HIGHWAY SUITE 6 SOUTHFIELD, MI 480758075 | BLUE CARE NETWORK OF MICHIGAN | -$3 | — | -$3 | -0.00% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC. | 333 INDUSTRIAL DR ADRIAN, MI 49221 | DEARBORN LIFE INSURANCE COMPANY | $16K | — | $16K | 15.00% |
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 | 214 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 220 | 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 | 285 | $1.2M |
| Dental | BLUE CROSS BLUE SHIELD OF MICHIGAN | 285 | $846K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 285 | $846K |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 115 | $104K |
| Short-term disability | DEARBORN LIFE INSURANCE COMPANY | 115 | $104K |
| Long-term disability | DEARBORN LIFE INSURANCE COMPANY | 115 | $104K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 285 | $1.2M |
| Other(2 contracts, 2 carriers) | DEARBORN LIFE INSURANCE COMPANY | 256 | $111K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 285 | — |
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.