| 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 | $49K | $62K | $111K | 9.24% |
| 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 | $51K | — | $51K | 13.65% |
| SMITH, THOMAS, CHRISTOPHER4 | 2928 FOSTER CREIGHTON DR NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $16K | — | $16K | 4.15% |
| 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 | $14K | — | $14K | 9.40% |
| J.S. CLARK AGENCY, INC.3 Filed as: JS CLARK AGENCY | 25900 W ELEVEN MILE ROAD, STE 210 SOUTHFIELD, MI 48034 | TRANSAMERICA | $3K | — | $3K | 10.74% |
| WEB TPA3 Filed as: WEB TPA EMPLOYER SERVICES LLC | 8500 FREEPORT PKWY S, STE 400 IRVING, TX 75063 | TRANSAMERICA | — | $2K | $2K | 8.47% |
| NATIONAL EMPLOYEE BENEFIT COMPANIES3 | 8500 FREEPORT PKWY S, STE 450 IRVING, TX 75063 | TRANSAMERICA | — | $1K | $1K | 5.44% |
| MITCH BESVINICK3 Filed as: MITCH BESVINIK/ INNOBENEFITS | 1280 BRIGHTON WAY NEWTOWN SQUARE, PA 19073 | TRANSAMERICA | — | $759 | $759 | 2.87% |
| NEW BENEFITS, LTC3 | 14240 PROTON ROAD DALLAS, TX 75244 | TRANSAMERICA | — | $197 | $197 | 0.74% |
| DAVID HERNANDEZ FINANCIAL SERVICES3 | PO BOX 292337 TEMPLE TERRACE, FL 336872337 | FREEZING IN FLORIDA VISION | $220 | — | $220 | 9.27% |
| 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 | $196 | — | $196 | 15.03% |
| 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 | $123 | — | $123 | 10.00% |
| 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 | $37K | $99K | $136K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| METROPOLITAN LIFE INSURANCE CO EIN 13-5581829 CONTRACT ADMIN | Claims processing Service code 12 | — | $43K |
| RX BENEFITS EIN 63-1157085 CONTRACT ADMIN | Contract Administrator Service code 13 | — | $30K |
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 | 1,568 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 24 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,592 | 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 | 2,118 | $156K |
| Life insurance(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,593 | $1.6M |
| Short-term disability(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,593 | $1.6M |
| Long-term disability(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,593 | $1.6M |
| Other(4 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,593 | $1.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,413 | — |
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.