| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| J.S. CLARK AGENCY, INC.3 | 25900 WEST 11 MILE RD., SUITE 210 SOUTHFIELD, MI 48034 | HEALTH ALLIANCE PLAN OF MICHIGAN | $23K | — | $23K | 1.12% |
| THE COLBURN CORPORATION3 | 3001 W. BIG BEAVER RD., SUITE 302 TROY, MI 48084 | HEALTH ALLIANCE PLAN OF MICHIGAN | $5K | — | $5K | 0.24% |
| SAFE HARBORS INC.3 Filed as: SAFE HARBORS, INC. | 3001 W. BIG BEAVER RD., SUITE 320 TROY, MI 48084 | HEALTH ALLIANCE PLAN OF MICHIGAN | $5K | — | $5K | 0.24% |
| THE COLBURN CORPORATION3 Filed as: COLBURN CORPORATION | 3001 W. BIG BEAVER RD., SUITE 302 TROY, MI 48084 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $11K | $193 | $11K | 1.22% |
| SAFE HARBORS INC.3 Filed as: SAFE HARBORS INCORPORATED | 3001 W. BIG BEAVER RD., SUITE 320 TROY, MI 48084 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $11K | $26 | $11K | 1.20% |
| J.S. CLARK AGENCY, INC.3 | 25900 WEST 11 MILE RD., SUITE 210 SOUTHFIELD, MI 48034 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $10K | $111 | $10K | 1.14% |
| J.S. CLARK AGENCY, INC.3 | 25900 WEST 11 MILE RD., SUITE 210 SOUTHFIELD, MI 48034 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $13K | — | $13K | 6.14% |
| SAFE HARBORS INC.3 | 3001 W. BIG BEAVER RD., SUITE 320 TROY, MI 48084 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 1.51% |
| THE COLBURN CORPORATION3 | 3001 W. BIG BEAVER RD., SUITE 302 TROY, MI 48084 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 1.51% |
| J.S. CLARK AGENCY, INC.3 | 25900 WEST 11 MILE RD., SUITE 210 SOUTHFIELD, MI 48034 | DELTA DENTAL OF MICHIGAN | $2K | — | $2K | 1.49% |
| SAFE HARBORS INC.3 Filed as: SAFE HARBORS INCORPORATED | 3001 W. BIG BEAVER RD., SUITE 320 TROY, MI 48084 | DELTA DENTAL OF MICHIGAN | $918 | — | $918 | 0.58% |
| THE COLBURN CORPORATION3 Filed as: COLBURN CORPORATION | 3001 W. BIG BEAVER RD., SUITE 302 TROY, MI 48084 | DELTA DENTAL OF MICHIGAN | $918 | — | $918 | 0.58% |
| J.S. CLARK AGENCY, INC.3 | 25900 WEST 11 MILE RD., SUITE 210 SOUTHFIELD, MI 48034 | HERITAGE VISION PLANS, INC. | $744 | — | $744 | 2.35% |
| THE COLBURN CORPORATION3 | 3001 W. BIG BEAVER RD., SUITE 302 TROY, MI 48084 | HERITAGE VISION PLANS, INC. | $739 | — | $739 | 2.33% |
| SAFE HARBORS INC.3 Filed as: SAFE HARBORS, INC. | 3001 W. BIG BEAVER RD., SUITE 320 TROY, MI 48084 | HERITAGE VISION PLANS, INC. | $739 | — | $739 | 2.33% |
| THE COLBURN CORPORATION3 | 3001 W. BIG BEAVER RD., SUITE 302 TROY, MI 48084 | VISION SERVICE PLAN | $663 | — | $663 | 2.43% |
| SAFE HARBORS INC.3 Filed as: SAFE HARBORS, INC. | 3001 W. BIG BEAVER RD., SUITE 320 TROY, MI 48084 | VISION SERVICE PLAN | $398 | — | $398 | 1.46% |
| J.S. CLARK AGENCY, INC.3 | 25900 WEST 11 MILE RD., SUITE 210 SOUTHFIELD, MI 48034 | VISION SERVICE PLAN | $265 | — | $265 | 0.97% |
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 | 287 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 150 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 437 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTH ALLIANCE PLAN OF MICHIGAN | 536 | $3.0M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF MICHIGAN | 552 | $193K |
| Vision(3 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 565 | $978K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 314 | $212K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 314 | $212K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 314 | $212K |
| Prescription drug(2 contracts, 2 carriers) | HEALTH ALLIANCE PLAN OF MICHIGAN | 536 | $3.0M |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 314 | $212K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 565 | — |
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.