| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAUL KAHLER3 | 25900 W 11 MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $12K | $15K | $27K | 1.01% |
| AMY J HALL3 | 25900 W 11 MILE ROAD STE 210 SOUTHFIELD, MI 48034 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $6K | $8K | $13K | 0.49% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY DBA OF ASSURED | 25900 W 11 MILE ROAD, STE 210 SOUTHFIELD, MI 48034 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $2K | $2K | 0.06% |
| PAUL KAHLER3 | 3099 BIDDLE AVE WYANDOTTE, MI 48192 | DELTA DENTAL OF MICHIGAN | $6K | — | $6K | 4.43% |
| AMY J HALL3 Filed as: AMY HALL | 3099 BIDDLE AVE WYANDOTTE, MI 48192 | DELTA DENTAL OF MICHIGAN | $544 | — | $544 | 0.38% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF MICHIGAN | 25900 W 11 MILE RD STE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 9.11% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $612 | $4K | $5K | 6.86% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $188 | $3K | $3K | 6.42% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF MICHIGANS | 25900 W 11 MILE RD STE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 4.56% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF MICHIGAN | 25900 W 11 MILE RD STE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 9.11% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $218 | $1K | $2K | 6.83% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF MICHIGAN | 25900 W. ELEVEN MILE, SUITE 210 SOUTHFIELD, MI 480348203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 20.00% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF MICHIGAN | 25900 W 11 MILE RD STE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 9.17% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $196 | $1K | $1K | 5.95% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF MICHIGAN | 25900 W 11 MILE RD STE 210 SOUTHFIELD, MI 48034 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 20.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Claims processing; Float revenue; Insurance services; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Direct payment from the plan; Contract Administrator Service code 12 | — | $126K |
| PAUL KAHLER AGENT | Other fees; Insurance agents and brokers; Other commissions; Non-monetary compensation; Insurance brokerage commissions and fees Service code 22 | 25900 W 11 MILE, STE 210 SOUTHFIELD, MI 480348203 | $34K |
| J.S. CLARK AGENCY, INC. EIN 38-2725572 AGENT | Other commissions; Insurance agents and brokers; Other fees; Insurance brokerage commissions and fees; Non-monetary compensation Service code 22 | 25900 W 11 MILE, STE 210 SOUTHFIELD, MI 480348203 | $17K |
| AMY HALL AGENT | Other commissions; Insurance brokerage commissions and fees; Non-monetary compensation; Other fees; Insurance agents and brokers Service code 22 | 25900 W 11 MILE RD STE 21 SOUTHFIELD, MI 48034 | $14K |
| ASSURED PARTNERS OF MICHIGAN LLC AGENT | Insurance brokerage commissions and fees; Non-monetary compensation; Insurance agents and brokers; Other commissions; Other fees Service code 22 | 25900 W 11 MILE RD STE 21 SOUTHFIELD, MI 48034 | $14K |
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 | 152 | 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) | 152 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 246 | $2.7M |
| Dental | DELTA DENTAL OF MICHIGAN | 256 | $142K |
| Vision | BLUE CROSS BLUE SHIELD OF MICHIGAN | 246 | $2.7M |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 137 | $48K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 136 | $69K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 137 | $42K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 246 | $2.7M |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 144 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 256 | — |
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.