Form 5500 · Employee benefit plan · ANN ARBOR, MI
EVERSIGHT
EVERSIGHT of ANN ARBOR, MI files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is KAPNICK & COMPANY, INC.. Coverage is written through DELTA DENTAL OF MICHIGAN and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 38-2117115 · plan 501 · plan year 2025, filed Jun 23, 2026
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
Benefits declared on this filing
Also declared: other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 2 insured contracts covering dental and disability; the largest, with DELTA DENTAL OF MICHIGAN, covers 269 people.
The filing declares dental, disability, health, vision and life. Health, vision and life appear with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.
Reported premium across the insured contracts is $182,241, with $11,794 in disclosed broker commissions — about 6.5% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
KAPNICK & COMPANY, INC. is the broker of record on 1 of the 2 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNUM LIFE INSURANCE COMPANY OF AMERICA | Disability | 154 | Jan 1, 2026 | $81,584 | $7,029 |
| DELTA DENTAL OF MICHIGAN | Dental | 269 | Jan 1, 2026 | $100,657 | $4,765 |
Premium and claims on this contract
DELTA DENTAL OF MICHIGAN, contract 0009532. For the contract year on this filing, the carrier reported $100,158 in premium earned and $86,239 in claims incurred. Dividing one by the other gives 86%.
- DELTA DENTAL OF MICHIGAN, contract 0009532 reported $15,605 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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