| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAY R SCHREIBMAN Filed as: JAY R. SCHRIEBMAN | LSG INSURANCE PARTNERS 2600 S. TELEGRAPH, S-100 BLOOMFIELD HILLS, MI 48302 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $66K | $141K | $206K | 11.93% |
| LSG INSURANCE PARTNERS3 | 2600 S TELEGRAPH ROAD BLOOMFIELD HILLS, MI 48302 | DELTA DENTAL OF MICHIGAN | $12K | — | $12K | 2.08% |
| LSG INSURANCE PARTNERS3 Filed as: LSG INSURANCE PARTNERS, INC. | 2600 S TELEGRAPH ROAD STE 100 BLOOMFIELD HILLS, MI 48302 | BLUE CARE NETWORK OF MICHIGAN | — | $10K | $10K | 2.16% |
| LSG INSURANCE PARTNERS3 Filed as: LSG INSURANCE PARTNERS, INC. | 2600 S TELEGRAPH ROAD STE 100 BLOOMFIELD HILLS, MI 48302 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $14K | — | $14K | 8.33% |
| LSG INSURANCE PARTNERS3 Filed as: LSG INSURANCE PARTNERS - BOR | 2600 SOUTH TELEGRAPH RD. BLOOMFIELD HILLS, MI 48302 | EYEMED VISION CARE | $10K | — | $10K | 8.83% |
| LSG INSURANCE PARTNERS3 Filed as: LSG INSURANCE PARTNERS, INC. | 2600 S. TELEGRAPH ROAD STE 100 BLOOMFIELD HILLS, MI 48302 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $46K | — | $46K | 41.42% |
| SCHREIBMAN, JAY3 Filed as: SCHREIBMAN, JAY, ROBERT | 2600 S. TELEGRAPH STE 100 BLOOMFIELD HILLS, MI 48302 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $15K | — | $15K | 13.53% |
| LSG INSURANCE PARTNERS Filed as: LSG INSURANCE PARTNERS, INC. | 2600 S TELEGRAPH ROAD STE 100 BLOOMFIELD HILLS, MI 48302 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $24K | — | $24K | 33.88% |
| SCHILLLER & ASSOCIATES LLC4 | 173 COTTAGE LN MILFORD, MI 48381 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $7K | — | $7K | 17.67% |
| LSG INSURANCE PARTNERS4 | 2600 S TELEGRAPH RD STE 100 BLOOMFIELD HILLS, MI 48302 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $3K | — | $3K | 7.70% |
| LSG INSURANCE PARTNERS3 Filed as: LSG INSURANCE PARTNERS, INC. | 2600 S TELEGRAPH ROAD SUITE 100 BLOOMFIELD HILLS, MI 48302 | FIRST UNUM LIFE INSURANCE COMPANY | $54 | — | $54 | 0.71% |
| LSG INSURANCE PARTNERS3 Filed as: LSG INSURANCE PARNTERS | 2600 S TELEGRAPH RD SUITE 100 BLOOMFIELD HILLS, MI 48302 | BLUE CARE NETWORK OF MICHIGAN | $11 | — | $11 | 0.45% |
| LSG INSURANCE PARTNERS3 Filed as: LSG INSURANCE PARTNERS, INC. | 2600 S TELEGRAPH ROAD STE 100 BLOOMFIELD HILLS, MI 48302 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $163 | — | $163 | 11.23% |
| 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 | — | $851K |
| LSG INS. PARTNERS/JAY SCHREIBMAN AGENT/BROKER | Other fees; Other commissions; Insurance brokerage commissions and fees; Non-monetary compensation; Insurance agents and brokers Service code 22 | 2600 S. TELEGRAPH S-100 BLOOMFIELD HILLS, MI 48302 | $206K |
| DELTA DENTAL OF MICHIGAN EIN 38-1791480 BENEFIT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $49K |
| UNUM LIFE INS. COMPANY OF AMERICA EIN 01-0278678 ADMIN. SERVICE PROVIDER | Claims processing Service code 12 | — | $0 |
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 | 1,483 | 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) | 1,483 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 1,306 | $625K |
| Dental | DELTA DENTAL OF MICHIGAN | 2,053 | $578K |
| Vision | EYEMED VISION CARE | 1,613 | $116K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,306 | $238K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 602 | $119K |
| Long-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,306 | $238K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 2,053 | $1.7M |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 602 | $113K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,053 | — |
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.