| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HOME OFFICE TPA PAYS COMMISSION3 | 475 FALLBROOK BOULEVARD LINCOLN, NE 685219033 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $12K | — | $12K | 12.63% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 N SHORE DRIVE PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | $786 | $5K | 17.59% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $393 | $2K | 6.29% |
| ADMINISTRATORS, INC, BOON-CHAPMAN B3 Filed as: ADMINISTRATORS, INC., BOON-CHAPMAN | 9401 AMBERGLEN BOULEVARD SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | $804 | $804 | 2.65% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 N SHORE DRIVE PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | $511 | $4K | 17.34% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $256 | $1K | 6.17% |
| ADMINISTRATORS, INC, BOON-CHAPMAN B3 Filed as: ADMINISTRATORS, INC., BOON-CHAPMAN | 9401 AMBERGLEN BOULEVARD SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $574 | $574 | 2.62% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 N SHORE DRIVE PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $248 | $2K | 16.66% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $480 | $124 | $604 | 6.29% |
| ADMINISTRATORS, INC, BOON-CHAPMAN B3 Filed as: ADMINISTRATORS, INC., BOON-CHAPMAN | 9401 AMBERGLEN BOULEVARD SUIT 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $260 | $260 | 2.71% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 N SHORE DRIVE PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $179 | $1K | 15.76% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $450 | $89 | $539 | 5.99% |
| ADMINISTRATORS, INC, BOON-CHAPMAN B3 Filed as: ADMINISTRATORS, INC., BOON-CHAPMAN | 9401 AMBERGLEN BOULEVARD SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $238 | $238 | 2.65% |
| GIS BENEFITS INC3 Filed as: GIS | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $89 | $89 | 0.99% |
| SEUBERT & ASSOCIATES, INC.3 | 225 N SHORE DRIVE PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $771 | — | $771 | 15.00% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 | INC. 9401 AMBERGLEN BLVD BLDG 1 STE.100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $257 | — | $257 | 5.00% |
| MARK METTILLE3 | C/O GROUP INSURANCE SERVICES, INC. 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $257 | — | $257 | 5.00% |
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 | 162 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 162 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | RELIANCE STANDARD LIFE INSURANCE COMPANY | 356 | $97K |
| Vision | RELIANCE STANDARD LIFE INSURANCE COMPANY | 356 | $97K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 99 | $30K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 86 | $22K |
| Other(4 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 99 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 356 | — |
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.