| 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 | $66K | — | $66K | 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 | $19K | $35K | 11.93% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF MI LLC | 3099 BIDDLE AVE WYANDOTTE, MI 48192 | DELTA DENTAL OF MICHIGAN | $7K | $0 | $7K | 2.74% |
| 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 | $632 | $0 | $632 | 0.26% |
| 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 | $7K | — | $7K | 3.02% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY INC | 25900 W ELEVEN MILE RD, SUITE 210 SOUTHFIELD, MI 48034 | EYEMED | $3K | $0 | $3K | 10.87% |
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 | 246 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 250 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PRIORITY HEALTH | 368 | $2.4M |
| Dental | DELTA DENTAL OF MICHIGAN | 508 | $247K |
| Vision | EYEMED | 512 | $25K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 243 | $296K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 243 | $296K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 243 | $296K |
| Prescription drug(2 contracts, 2 carriers) | PRIORITY HEALTH | 368 | $2.4M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 243 | $296K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 512 | — |
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."
No prospect flags tripped on this filing.