| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAUL KAHLER3 | 25900 W 11 MILE RD, SUITE 210 SOUTHFIELD, MI 480348203 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $17K | $23K | $40K | 1.21% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY | 25900 W 11 MILE RD, SUITE 210 SOUTHFIELD, MI 480348203 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $2K | $9K | $12K | 0.35% |
| J.S. CLARK AGENCY, INC.3 | 25900 W. 11 MILE ROAD, SUITE 210 SOUTHFIELD, MI 48034 | DELTA DENTAL OF MICHIGAN | $11K | — | $11K | 4.73% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $11K | $6K | $17K | 15.63% |
| J.S. CLARK AGENCY, INC.3 Filed as: JS CLARK AGENCY INC | 25900 W. ELEVEN MILE, SUITE 210 SOUTHFIELD, MI 480348203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 20.00% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $3K | $9K | 15.99% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $3K | $6K | 11.10% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 15.69% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Other fees; Consulting (general); Float revenue; Insurance services; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $157K |
| J.S. CLARK AGENCY, INC. EIN 38-2725572 AGENT | Insurance brokerage commissions and fees; Other commissions; Other fees; Insurance agents and brokers; Non-monetary compensation Service code 22 | 25900 W 11 MILE, STE 210 SOUTHFIELD, MI 480348203 | $47K |
| PAUL KAHLER AGENT | Other fees; Insurance agents and brokers; Insurance brokerage commissions and fees; Non-monetary compensation; Other commissions Service code 22 | 25900 W 11 MILE, STE 210 SOUTHFIELD, MI 480348203 | $40K |
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 | 445 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 445 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 184 | $3.3M |
| Dental | DELTA DENTAL OF MICHIGAN | 445 | $240K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 184 | $3.3M |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 197 | $86K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 197 | $110K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 197 | $53K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 184 | $3.3M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 197 | $112K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 445 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.