| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 N SHORE DRIVE. STE 300 PITTSBURGH, PA 15212 | UNITEDHEALTHCARE INSURANCE COMPANY | $22K | — | $22K | 2.68% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 N SHORE DRIVE. STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | $455 | $4K | 17.07% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $260 | $1K | 6.18% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 N SHORE DRIVE. STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $348 | $2K | 18.57% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $487 | $199 | $686 | 7.05% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 N SHORE DRIVE. STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $593 | $124 | $717 | 18.13% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $198 | $71 | $269 | 6.80% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $189 | $44 | $233 | 6.16% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 N SHORE DRIVE. STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $132 | $77 | $209 | 5.52% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 N SHORE DRIVE. STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $520 | $92 | $612 | 17.65% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $173 | $52 | $225 | 6.49% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 N SHORE DRIVE. STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $49 | — | $49 | 4.97% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | 9401 AMBERGLEN BLVD. BUILDING 1 STE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $49 | — | $49 | 4.97% |
| MARK METTILLE3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $49 | — | $49 | 4.97% |
| GIS BENEFITS INC3 Filed as: GIS NATIONAL | 9500 KOGER AVE. STE 200 ST. PETERSBURG, FL 33702 | METLIFE LEGAL PLANS | $88 | — | $88 | 10.02% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES | 225 NORTH SHORE DR. STE 300 PITTSBURGH, PA 15212 | METLIFE LEGAL PLANS | $88 | — | $88 | 10.02% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | PO BOX 9201 BUILDING 1 STE 100 AUSTIN, TX 78766 | METLIFE LEGAL PLANS | — | $44 | $44 | 5.01% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 N SHORE DRIVE. STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $112 | $21 | $133 | 17.76% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $37 | $12 | $49 | 6.54% |
No Schedule C service providers reported on this filing.
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 | 134 | 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) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 148 | $817K |
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 148 | $817K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 148 | $817K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 77 | $22K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 39 | $10K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 9 | $4K |
| Other(6 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 88 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 148 | — |
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.