| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAUL KAHLER3 | 25900 W. 11 MILE RD, SUITE 210 SOUTHFIELD, MI 480348034 | BLUE CARE NETWORK OF MICHIGAN | $25K | — | $25K | 3.28% |
| AMY J HALL3 | 25900 W. 11 MILE RD STE 210 SOUTHFIELD, MI 480348034 | BLUE CARE NETWORK OF MICHIGAN | $10K | — | $10K | 1.27% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF MI LLC | 25900 W. 11 MILE RD, SUITE 210 SOUTHFIELD, MI 480348034 | BLUE CARE NETWORK OF MICHIGAN | — | $864 | $864 | 0.11% |
| AMY J HALL3 | 25900 W. 11 MILE RD STE 210 SOUTHFIELD, MI 480348034 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $2K | — | $2K | 2.51% |
| PAUL KAHLER3 | 25900 W. 11 MILE RD, SUITE 210 SOUTHFIELD, MI 480348034 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $2K | — | $2K | 2.20% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF MI LLC | 25900 W. 11 MILE RD, SUITE 210 SOUTHFIELD, MI 480348034 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $36 | $36 | 0.04% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF MICHIGAN, LLC | 3099 BIDDLE AVENUE WYANDOTTE, MI 48192 | DELTA DENTAL OF MICHIGAN | $4K | — | $4K | 4.82% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF MICHIGAN LLC | 25900 W 11 MILE RD STE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 9.18% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD STE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $457 | $3K | $3K | 6.23% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF MICHIGAN LLC | 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 Filed as: J. S. CLARK AGENCY, INC | 25900 W. 11 MILE RD STE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $192 | $1K | $2K | 6.76% |
| J.S. CLARK AGENCY, INC.3 | C/O FRANKLIN BANK 25900 W. 11 MILE RD, SUITE 210 SOUTHFIELD, MI 480348034 | VISION SERVICE PLAN | $781 | — | $781 | 4.08% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS CAPITAL INC | 25900 W 11 MILE RD STE 210 SOUTHFIELD, MI 48034 | VISION SERVICE PLAN | $577 | — | $577 | 3.02% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF MICHIGAN LLC | 25900 W 11 MILE RD STE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 9.23% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD STE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $128 | $920 | $1K | 6.31% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF MICHIGAN LLC | 25900 W 11 MILE RD STE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 13.76% |
| J.S. CLARK AGENCY, INC.3 | 25900 W 11 MILE RD STE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $202 | $924 | $1K | 6.93% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PAUL KAHLER AGENT | Insurance brokerage commissions and fees; Other fees; Insurance agents and brokers; Other commissions; Non-monetary compensation Service code 22 | 25900 W 11 MILE RD STE210 SOUTHFIELD, MI 480348034 | $27K |
| ASSURED PARTNERS OF MICHIGAN LLC BROKER | Non-monetary compensation; Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers; Other fees Service code 22 | 25900 W 11 MILE RD ST 210 SOUTHFIELD, MI 48034 | $16K |
| AMY J HALL AGENT | Insurance brokerage commissions and fees; Non-monetary compensation; Insurance agents and brokers; Other fees; Other commissions Service code 22 | 25900 W 11 MILE RD ST 210 SOUTHFIELD, MI 480348034 | $12K |
| J.S. CLARK AGENCY, INC. BROKER | Insurance brokerage commissions and fees; Non-monetary compensation; Insurance agents and brokers; Other commissions; Other fees Service code 22 | 25900 W 11 MILE RD STE210 SOUTHFIELD, MI 480348034 | $8K |
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 | 103 | 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) | 103 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 177 | $847K |
| Dental | DELTA DENTAL OF MICHIGAN | 194 | $83K |
| Vision | VISION SERVICE PLAN | 73 | $19K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 103 | $33K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 103 | $55K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 103 | $23K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 177 | $847K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 103 | $33K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 194 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.