| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC | 233 S WACKER DRIVE SUITE 2000 CHICAGO, IL 60606 | PRIORITY HEALTH INSURANCE COMPANY | $19K | — | $19K | 3.00% |
| HALL, AMY J3 | 25900 W ELEVEN MILE RD. SUITE 210 SOUTHFIELD, MI 48034 | PRIORITY HEALTH INSURANCE COMPANY | $6K | — | $6K | 1.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC | 233 S WACKER DRIVE SUITE 2000 CHICAGO, IL 60606 | PRIORITY HEALTH | $4K | — | $4K | 2.93% |
| HALL, AMY J3 | 25900 W ELEVEN MILE RD. SUITE 210 SOUTHFIELD, MI 48034 | PRIORITY HEALTH | $2K | — | $2K | 1.07% |
| J.S. CLARK AGENCY, INC.3 Filed as: JS CLARK AGENCY | 25900 W 11 MILE RD. SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $908 | $6K | $7K | 6.49% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC | 233 S WACKER DRIVE CHICAGO, IL 60606 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 3.97% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC | 330 W COLLEGE AVE APPLETON, WI 54911 | DELTA DENTAL OF MICHIGAN | $2K | — | $2K | 2.42% |
| J.S. CLARK AGENCY, INC.3 Filed as: JS CLARK AGENCY | 25900 W ELEVEN MILE RD. SUITE 210 SOUTHFIELD, MI 48034 | DELTA DENTAL OF MICHIGAN | $531 | $175 | $706 | 0.90% |
| J.S. CLARK AGENCY, INC.3 Filed as: JS CLARK AGENCY | 25900 W 11 MILE RD. SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $779 | $4K | $5K | 6.92% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC | 233 S WACKER DRIVE SUITE 2000 CHICAGO, IL 60606 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 5.95% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC | 233 S WACKER DRIVE SUITE 2000 CHICAGO, IL 60606 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 8.06% |
| J.S. CLARK AGENCY, INC.3 Filed as: JS CLARK AGENCY | 25900 W 11 MILE RD. SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $311 | $2K | $2K | 6.39% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF MICHIGAN LLC | 25900 WEST ELEVEN MILE RD SOUTHFIELD, MI 48034 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | $2K | — | $2K | 6.10% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ILLINOIS INC | 233 S WACKER DRIVE SUITE 2000 CHICAGO, IL 60606 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | $1K | — | $1K | 3.08% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC | 233 S WACKER DRIVE SUITE 2000 CHICAGO, IL 60606 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 13.08% |
| J.S. CLARK AGENCY, INC.3 Filed as: JS CLARK AGENCY | 25900 W 11 MILE RD. SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $447 | $2K | $2K | 6.81% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF MICHIGAN LLC | 25900 WEST ELEVEN MILE RD SOUTHFIELD, MI 48034 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | $425 | $10K | 35.55% |
| GRIFFIN, STEVEN, RAY3 | 2000 MORRIS AVE STE 1400 BIRMINGHAM, AL 35203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $140 | $1K | 5.29% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC. | 233 S WACKER DRIVE SUITE 2000 CHICAGO, IL 60606 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $162 | $15 | $177 | 0.63% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF MICHIGAN LLC | 25900 WEST ELEVEN MILE RD SOUTHFIELD, MI 48034 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $176 | $5K | 86.17% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC | 233 S WACKER DRIVE SUITE 2000 CHICAGO, IL 60606 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $82 | $6 | $88 | 1.47% |
| J.S. CLARK AGENCY, INC.4 Filed as: JS CLARK AGENCY | 25900 W 11 MILE RD. SUITE 210 SOUTHFIELD, MI 48034 | PRE-PAID LEGAL SERVICES INC DBA LEGAL SHIELD | $287 | — | $287 | 5.33% |
| SCHILLER & ASSOCIATES LLC4 Filed as: SCHILLER AND ASSOCIATES LLC | 173 COTTAGE LN MILFORD, MI 48381 | PRE-PAID LEGAL SERVICES INC DBA LEGAL SHIELD | $244 | — | $244 | 4.53% |
| DANA JO WARTELL4 | 5470 VAN NESS DR BLOOMFIELD HILLS, MI 48302 | PRE-PAID LEGAL SERVICES INC DBA LEGAL SHIELD | $128 | — | $128 | 2.38% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF MICHIGAN LLC | 25900 WEST ELEVEN MILE RD SOUTHFIELD, MI 48034 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | $9 | — | $9 | 9.18% |
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 | 227 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 233 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PRIORITY HEALTH INSURANCE COMPANY | 139 | $769K |
| Dental | DELTA DENTAL OF MICHIGAN | 0 | $78K |
| Vision(2 contracts) | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | 0 | $35K |
| Life insurance(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $78K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $113K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $65K |
| Prescription drug(2 contracts, 2 carriers) | PRIORITY HEALTH INSURANCE COMPANY | 139 | $769K |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 32 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 139 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.