| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DEVON J DOBRIN3 | 901 WILSHIRE DRIVE, STE 330 TROY, MI 480848084 | BLUE CARE NETWORK OF MICHIGAN | $28K | — | $28K | 2.64% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY | 25900 W 11 MILE ROAD, STE 210 SOUTHFIELD, MI 480348034 | BLUE CARE NETWORK OF MICHIGAN | — | $1K | $1K | 0.11% |
| DEVON J DOBRIN3 | 901 WILSHIRE DRIVE, STE 330 TROY, MI 480848084 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $3K | — | $3K | 2.94% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY | 25900 W 11 MILE ROAD, STE 210 SOUTHFIELD, MI 480348034 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $55 | $55 | 0.06% |
| WILSHIRE BENEFITS GROUP INC3 Filed as: WILSHIRE BENEFITS GROUP, INC | 901 WILSHIRE DRIVE, SUITE 330 TROY, MI 48084 | DELTA DENTAL OF MICHIGAN | $4K | $22 | $4K | 5.42% |
| WILSHIRE BENEFITS GROUP INC Filed as: WILSHIRE BENEFITS GROUP, INC | 901 WILSHIRE DRIVE, SUITE 330 TROY, MI 48084 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 10.73% |
| KRISTINA O'CONNOR4 Filed as: KRISTINA L. O'CONNOR | 901 WILSHIRE DRIVE, SUITE 330 TROY, MI 48084 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $103 | — | $103 | 0.30% |
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 | 223 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 223 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 198 | $1.1M |
| Dental | DELTA DENTAL OF MICHIGAN | 221 | $74K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 114 | $35K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 114 | $35K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 198 | $1.1M |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 114 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 221 | — |
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."
No prospect flags tripped on this filing.