| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| J.S. CLARK AGENCY, INC.3 Filed as: J. S CLARK AGENCY | 25900 W. ELEVEN MILE ROAD SOUTHFIELD, MI 48034 | BLUE CARE NETWORK OF MICHIGAN | $56K | — | $56K | 5.17% |
| J.S. CLARK AGENCY, INC.3 Filed as: J S CLARK AGENCY | 25900 W 11 MILE ROAD SUITE 210 SOUTHFIELD, MI 480348203 | BLUE CROSS & BLUE SHIELD OF MICHIGAN | $19K | — | $19K | 3.93% |
| JOEL CLARK3 | 25900 W ELEVEN MILE ROAD SOUTHFILED, MI 48034 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $5K | $5K | 3.56% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY | 25900 W ELEVEN MILE ROAD SOUTHFIELD, MI 48034 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $795 | $795 | 0.63% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY | 25900 W. ELEVEN MILE ROAD SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $2K | $3K | 10.08% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY | 25900 W 11 MILE RD. SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $2K | $6K | 21.49% |
| J.S. CLARK AGENCY, INC.3 Filed as: J S CLARK AGENCY | 25900 WEST 11 MILE ROAD SUITE 210 SOUTHFIELD, MI 48034 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 9.22% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY | 25900 W ELEVEN MILE ROAD SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $864 | $3K | 14.54% |
| ROY LAMPHIER3 | 11 CAMBRIDGE BLVD. PLEASANT RIDGE, MI 48069 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.00% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY | 25900 W. ELEVEN MILE RD. SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $663 | $3K | 20.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Contract Administrator; Direct payment from the plan; Insurance services; Consulting (general); Other fees; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | — | $6K |
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 | 151 | 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) | 151 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 254 | $1.6M |
| Dental | BLUE CROSS BLUE SHIELD OF MICHIGAN | 124 | $127K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 285 | $20K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 159 | $49K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 159 | $33K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 41 | $13K |
| Prescription drug | BLUE CARE NETWORK OF MICHIGAN | 254 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 285 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.