| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| J.S. CLARK AGENCY, INC.3 Filed as: J. S. CLARK AGENCYJ | 25900 W 11 MILE ROAD SUITE 210 SOUTHFIELD, MI 48034 | PRIORITY HEALTH | $45K | $0 | $45K | 4.45% |
| J.S. CLARK AGENCY, INC.3 | 25900 W. 11 MILE RD. SUITE 210 SOUTHFIELD, MI 48034 | DELTA DENTAL OF MICHIGAN | $247K | $383K | $630K | 1250.02% |
| J.S. CLARK AGENCY, INC.3 | 25900 W. 11 MILE ROAD SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $1K | $5K | 16.60% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE ROAD SUITE 210 SOUTHFIELD, MI 48034 | UNTIED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 14.28% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY | 25900 W 11 MILE ROAD SUITE 210 SOUTHFIELD, MI 48034 | MUTUAL OF OMAHA INSURANCE COMPANY | $2K | $1K | $3K | 14.83% |
| J.S. CLARK AGENCY, INC.3 | 25900 WEST ELEVEN MILE ROAD SUITE 210 SOUTHFIELD, MI 48034 | NATIONAL VISION ADMINISTRATORS, LLC | $1K | $0 | $1K | 10.00% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD. SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $648 | $3K | 20.18% |
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 | 161 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 161 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PRIORITY HEALTH | 270 | $1.0M |
| Dental | DELTA DENTAL OF MICHIGAN | 231 | $50K |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 269 | $14K |
| Life insurance | MUTUAL OF OMAHA INSURANCE COMPANY | 161 | $22K |
| Short-term disability | UNTIED OF OMAHA LIFE INSURANCE COMPANY | 161 | $25K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 161 | $30K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 270 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.