Form 5500 · Employee benefit plan · GRAND HAVEN, MI
JSJ CORPORATION
The filing calls this plan JSJ CORPORATION GROUP WELFARE PLAN.
Public Form 5500 records show how JSJ CORPORATION of GRAND HAVEN, MI, a manufacturing employer, structures its employee benefits. Its broker of record is GUYLAINE DONAVAN. Coverage is written through PRIORITY HEALTH and 7 other carriers. The plan's most recent policy period ended in June.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 38-1941886 · plan 501 · plan year 2025, filed Oct 28, 2025
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112 other employer plans in Michigan have policy years ending in June. See the full list on the renewal calendar, or ask for it in Claude or ChatGPT.
How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
One contract on this filing does not say which benefits it covers, so a line above may be insured by it.
Also declared: death benefits, other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 8 insured contracts covering health, vision and life; the largest, with PRIORITY HEALTH, covers 1,194 people.
The filing declares health, vision, life and dental. Dental appears with no insured contract on Schedule A. That coverage may be self-funded, placed with a carrier that is not on this filing, or written on the contract here that does not say what it covers.
Reported premium across the insured contracts is $9,718,182, with $275,861 in disclosed broker commissions — about 2.8% of premium.
The most recent policy period ended in June, and the plan year ends June 30. Group contracts typically renew on that annual cycle.
GUYLAINE DONAVAN is the broker of record on 2 of the 8 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| PRIORITY HEALTH | Health | 1,194 | Jul 1, 2025 | $6,619,942 | $115,849 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Life | 1,835 | Jul 1, 2025 | $370,387 | $71,673 |
| FLORIDA HEALTH CARE PLANS, INC. | Health | 180 | Jul 1, 2025 | $1,212,363 | $42,433 |
| STANDARD INSURANCE COMPANY | Health | 152 | Jul 1, 2025 | $127,428 | $23,279 |
| PRIORITY HEALTH INSURANCE COMPANY | Health | 145 | Jul 1, 2025 | $1,265,996 | $22,155 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health | 1 | May 2, 2025 | $4,718 | $472 |
| VISION SERVICE PLAN | Vision | 492 | Jul 1, 2025 | $104,317 | $0 |
| AETNA BEHAVIORAL HEALTH, LLC | — | 700 | Jul 1, 2025 | $13,031 | $0 |
Premium and claims on this contract
FLORIDA HEALTH CARE PLANS, INC., contract 172. For the contract year on this filing, the carrier reported $1,212,363 in premium earned and $1,080,351 in claims incurred. Dividing one by the other gives 89%.
- FLORIDA HEALTH CARE PLANS, INC., contract 172 reported $132,012 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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Renewal calendar
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