| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY | 25900 W 11 MILE ROAD SUITE 210 SOUTHFIELD, MI 48034 | BLUE CARE NETWORK OF MICHIGAN | $50K | — | $50K | 4.75% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY | 25900 W 11 MILE ROAD SUITE 210 SOUTFHFIELD, MI 48034 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $20K | — | $20K | 3.76% |
| JOEL CLARK3 | 25900 W 11 MILE ROAD SUITE 210 SOUTHFIELD, MI 48034 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $3K | $5K | $7K | 6.13% |
| ACTION BENEFITS COMPANY3 | 26533 EVERGREEN RD SUITE 400 SOUTHFIELD, MI 48076 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $848 | $0 | $848 | 0.72% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY | 25900 W 11 MILE SUITE 210 SOUTHFIELD, MI 48034 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $483 | $483 | 0.41% |
| J.S. CLARK AGENCY, INC.3 Filed as: JS CLARK AGENCY | 25900 WEST 11 MILE ROAD SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $2K | $6K | 19.79% |
| J.S. CLARK AGENCY, INC.3 Filed as: JS CLARK AGENCY | 25900 WEST 11 MILE ROAD SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $2K | $3K | 10.65% |
| J.S. CLARK AGENCY, INC.3 Filed as: JS CLARK AGENCY | 25900 WEST 11 MILE ROAD SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $499 | $2K | 12.86% |
| ROY LAMPHIER3 | 11 CAMBRIDGE BLVD PLEASANT RIDGE, MI 48069 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| J.S. CLARK AGENCY, INC.3 Filed as: JS CLARK AGENCY | 25900 WEST 11 MILE ROAD SUITE 210 SOUTHFIELD, MI 48034 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 10.94% |
| J.S. CLARK AGENCY, INC.3 Filed as: JS CLARK AGENCY | 25900 WEST 11 MILE ROAD SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $694 | $3K | 20.54% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Insurance services; Direct payment from the plan; Consulting (general); Contract Administrator; Other fees; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | — | $7K |
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 | 169 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 171 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 275 | $1.6M |
| Dental | BLUE CROSS BLUE SHIELD OF MICHIGAN | 140 | $117K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 263 | $17K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 150 | $49K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 150 | $31K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 43 | $13K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 275 | $1.6M |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 150 | $49K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 275 | — |
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.