| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF MI | 25900 W 11 MILE ROAD STE 210 SOUTHFIELD, MI 48034 | BLUE CARE NETWORK OF MICHIGAN | $30K | $2K | $32K | 1.82% |
| NAILE PALAJ3 | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | BLUE CARE NETWORK OF MICHIGAN | $22K | — | $22K | 1.25% |
| 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 | $3K | $5K | $8K | 9.38% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DR ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 1.70% |
| 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 | $4K | $2K | $6K | 13.56% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DR ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 5.14% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF MICHIGAN, LLC | 25900 WEST ELEVEN MILE RD SOUTHFIELD, MI 48034 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE | $2K | — | $2K | 6.79% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK INSURANCE GROUP | 333 INDUSTRIAL DRIVE ADRIAN, MI 49221 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE | $638 | — | $638 | 2.35% |
| 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 | $2K | $1K | $3K | 13.86% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DR ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 5.05% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF MICHIGAN | 25900 W ELEVEN MILE ROAD STE 210 SOUTHFIELD, MI 48034 | GUARDIAN LIFE INSURANCE COMPANY | $4K | $581 | $5K | 21.67% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DR ADRIAN, MI 49221 | GUARDIAN LIFE INSURANCE COMPANY | $1K | — | $1K | 5.95% |
| LIFETIME FINANCIAL GROWTH OF MI3 | 29800 TELEGRAPH RD SOUTHFIELD, MI 48034 | GUARDIAN LIFE INSURANCE COMPANY | $128 | — | $128 | 0.58% |
| 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 | $1K | $573 | $2K | 9.74% |
| KAPNICK & COMPANY, INC.3 Filed as: KAPNICK & COMPANY INC | 333 INDUSTRIAL DR ADRIAN, MI 49221 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 6.80% |
| ROY LAMPHIER3 | 11 CAMBRIDGE BLVD PLEASANT RIDGE, MI 48069 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 6.60% |
| JOEL CLARK3 | 25900 W. 11 MILE ROAD STE 210 SOUTHFIELD, MI 48034 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $3K | $3K | — |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY | 25900 W. 11 MILE ROAD STE 210 SOUTHFIELD, MI 48034 | BLUE CROSS BLUE SHIELD OF MICHIGAN | — | $223 | $223 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Claims processing; Other fees; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Direct payment from the plan; Contract Administrator; Insurance services Service code 12 | — | $11K |
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 | 186 | 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) | 186 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CARE NETWORK OF MICHIGAN | 361 | $1.8M |
| Dental | BLUE CROSS BLUE SHIELD OF MICHIGAN | 402 | $0 |
| Vision | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE | 356 | $27K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 190 | $64K |
| Short-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 189 | $102K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 78 | $25K |
| Prescription drug | BLUE CARE NETWORK OF MICHIGAN | 361 | $1.8M |
| Other | GUARDIAN LIFE INSURANCE COMPANY | 53 | $22K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 402 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.