| 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 | $18K | $23K | $41K | 1.27% |
| 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 | $3K | $4K | $7K | 0.22% |
| J.S. CLARK AGENCY, INC.3 | 25900 W. 11 MILE ROAD, SUITE 210 SOUTHFIELD, MI 48034 | DELTA DENTAL OF MICHIGAN | $11K | — | $11K | 4.72% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $12K | $7K | $18K | 15.60% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $3K | $9K | 15.63% |
| 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 | 10.60% |
| 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 | $10K | — | $10K | 18.39% |
| 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 | 15.82% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Claims processing Service code 12 | — | $170K |
| J.S. CLARK AGENCY, INC. EIN 38-2725572 AGENT | Insurance agents and brokers Service code 22 | 25900 W 11 MILE, STE 210 SOUTHFIELD, MI 480348203 | $48K |
| PAUL KAHLER AGENT | Insurance agents and brokers Service code 22 | 25900 W 11 MILE, STE 210 SOUTHFIELD, MI 480348203 | $41K |
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 | 462 | 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) | 462 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 194 | $3.3M |
| Dental | DELTA DENTAL OF MICHIGAN | 462 | $232K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 194 | $3.3M |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 210 | $90K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 210 | $118K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 210 | $56K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 194 | $3.3M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 210 | $113K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 462 | — |
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.