| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | $3K | $7K | 22.03% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | EQUITABLE FINANCIAL LIFE INSURANCE CO OF AMERICA | — | $545 | $545 | 5.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAMBRIDGE LIFE BROKRAGE, LLC EIN 45-2642901 BROKER | Direct payment from the plan; Insurance agents and brokers; Other services; Contract Administrator Service code 13 | — | $42K |
| ALLIED BENEFIT SYSTEMS, LLC EIN 36-3086057 TPA | Other services; Contract Administrator; Claims processing; Direct payment from the plan Service code 12 | — | $33K |
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 PPO | Other services; Direct payment from the plan Service code 49 | — | $16K |
| SUN LIFE ASSURANCE OF CANADA EIN 38-1082080 ASO | Claims processing; Contract Administrator Service code 12 | — | $9K |
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 | 105 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 85 | $33K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 113 | $44K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 85 | $33K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 85 | $33K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE OF CANADA | 82 | $371K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 113 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.