| 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 | $19K | $23K | $42K | 1.97% |
| J.S. CLARK AGENCY, INC.3 | 25900 W. 11 MILE ROAD, SUITE 210 SOUTHFIELD, MI 48034 | DELTA DENTAL OF MICHIGAN | $7K | $245 | $7K | 4.84% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $5K | $12K | 17.72% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $2K | $4K | 11.02% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF MICHIGAN | 25900 W. ELEVEN MILE, SUITE 210 SOUTHFIELD, MI 480348203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 20.09% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $2K | $5K | 20.67% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $3K | 17.04% |
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 | 310 | 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) | 310 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 138 | $2.1M |
| Dental | DELTA DENTAL OF MICHIGAN | 310 | $149K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 138 | $2.1M |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 148 | $43K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 148 | $66K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 148 | $40K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 138 | $2.1M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 154 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 310 | — |
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.