| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| J.S. CLARK AGENCY, INC.3 Filed as: J. S. CLARK AGENCY, INC. | 25900 W. 11 MILE ROAD, SUITE 210 SOUTHFIELD, MI 48034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $52K | $62K | $113K | 8.84% |
| J.S. CLARK AGENCY, INC.3 Filed as: J. S. CLARK AGENCY, INC. | 25900 W. 11 MILE ROAD, SUITE 210 SOUTHFIELD, MI 48034 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $70K | — | $70K | 17.07% |
| SMITH, THOMAS, CHRISTOPHER | 2928 FOSTER CREIGHTON DR NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $30K | — | $30K | 7.31% |
| J.S. CLARK AGENCY, INC.3 Filed as: J. S. CLARK AGENCY, INC. | 25900 W. 11 MILE ROAD, SUITE 210 SOUTHFIELD, MI 48034 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO | $15K | — | $15K | 10.76% |
| J.S. CLARK AGENCY, INC.3 Filed as: JS CLARK AGENCY | 25900 W ELEVEN MILE ROAD, STE 210 SOUTHFIELD, MI 48034 | TRANSAMERICA | $6K | — | $6K | 10.68% |
| WEB TPA Filed as: WEB TPA EMPLOYER SERVICES LLC | 8500 FREEPORT PKWY S, STE 400 IRVING, TX 75063 | TRANSAMERICA | — | $5K | $5K | 8.31% |
| NATIONAL EMPLOYEE BENEFIT COMPANIES | 8500 FREEPORT PKWY S, STE 450 IRVING, TX 75063 | TRANSAMERICA | — | $3K | $3K | 5.06% |
| MITCH BESVINICK Filed as: MITCH BESVINIK/ INNOBENEFITS | 1280 BRIGHTON WAY NEWTOWN SQUARE, PA 19073 | TRANSAMERICA | — | $2K | $2K | 2.87% |
| NEW BENEFITS, LTC | 14240 PROTON ROAD DALLAS, TX 75244 | TRANSAMERICA | — | $445 | $445 | 0.79% |
| DAVID HERNANDEZ FINANCIAL SERVICES3 | PO BOX 292337 TEMPLE TERRACE, FL 336872337 | FREEZING IN FLORIDA VISION | $294 | — | $294 | 10.01% |
| J.S. CLARK AGENCY, INC.3 Filed as: J. S. CLARK AGENCY, INC. | 25900 W. 11 MILE ROAD, SUITE 210 SOUTHFIELD, MI 48034 | GERBER LIFE & ACCIDENT INSURANCE COMPANY | $214 | — | $214 | 15.02% |
| J.S. CLARK AGENCY, INC.3 Filed as: J S CLARK AGENCY | 25900 WEST ELEVEN MILE RD STE 210 SOUTHFIELD, MI 48034 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO | $9 | — | $9 | 10.34% |
| J.S. CLARK AGENCY, INC.3 Filed as: J.S. CLARK AGENCY, INC | 25900 W 11 MILE ROAD, SUITE 210 SOUTHFIELD, MI 48034 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $138K | — | $138K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXPRESS SCRIPTS, INC. EIN 22-3461740 CONTRACT ADMIN | Claims processing; Contract Administrator Service code 12 | — | $106K |
| METROPOLITAN LIFE INSURANCE CO EIN 13-5581829 CONTRACT ADMIN | Contract Administrator; Claims processing Service code 12 | — | $47K |
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 | 1,831 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 23 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,854 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision(3 contracts, 2 carriers) | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO | 2,468 | $144K |
| Life insurance(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,831 | $1.7M |
| Short-term disability(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,831 | $1.7M |
| Long-term disability(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,831 | $1.7M |
| Other(4 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,831 | $1.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,906 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.