| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY INC | 25900 W ELEVEN MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | PRIORITY HEALTH | $68K | $0 | $68K | 3.03% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY INC | 25900 W ELEVEN MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $17K | $20K | $37K | 12.00% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY INC | 25900 W ELEVEN MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | DELTA DENTAL OF MICHIGAN | $8K | $505 | $8K | 3.20% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY INC | 25900 W ELEVEN MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | PRIORITY HEALTH INSURANCE COMPANY | $6K | $0 | $6K | 3.00% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY INC | 25900 W ELEVEN MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | EYEMED | $2K | $0 | $2K | 9.18% |
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 | 264 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 264 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PRIORITY HEALTH | 414 | $2.4M |
| Dental | DELTA DENTAL OF MICHIGAN | 541 | $258K |
| Vision | EYEMED | 564 | $27K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 264 | $309K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 264 | $309K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 264 | $309K |
| Prescription drug(2 contracts, 2 carriers) | PRIORITY HEALTH | 414 | $2.4M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 264 | $309K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 564 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.