| 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 | $16K | — | $16K | 15.89% |
| SEUBERT & ASSOCIATES, INC.3 | 225 N SHORE DRIVE PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | $649 | $5K | 17.14% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 5.00% |
| GIS BENEFITS INC3 Filed as: GIS | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $279 | $279 | 0.92% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 | INC. 9401 AMBERGLEN BLVD BLDG 1 STE.100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 N SHORE DRIVE PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | $449 | $4K | 16.81% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $0 | $1K | 5.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $196 | $196 | 0.79% |
| 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 | — | $0 | 0.00% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 N SHORE DRIVE PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $962 | $210 | $1K | 12.19% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $481 | — | $481 | 5.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $90 | $90 | 0.94% |
| ADMINISTRATORS, INC, BOON-CHAPMAN B3 Filed as: ADMINISTRATORS, INC., BOON-CHAPMAN | 9401 AMBERGLEN BOULEVARD SUIT 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 N SHORE DRIVE PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $808 | $182 | $990 | 12.25% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $404 | — | $404 | 5.00% |
| GIS BENEFITS INC3 Filed as: GIS | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $80 | $80 | 0.99% |
| ADMINISTRATORS, INC, BOON-CHAPMAN B3 Filed as: ADMINISTRATORS, INC., BOON-CHAPMAN | 9401 AMBERGLEN BOULEVARD SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 N SHORE DRIVE PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $934 | — | $934 | 15.01% |
| ADMINISTRATORS, INC, BOON-CHAPMAN B3 Filed as: ADMINISTRATORS, INC., BOON-CHAPMAN | 9401 AMBERGLEN BOULEVARD SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $311 | — | $311 | 5.00% |
| MARK METTILLE3 Filed as: MARK METTILLE C/O GROUP INSURANCE | SVCS INC. 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $311 | — | $311 | 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 | 196 | 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) | 196 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | RELIANCE STANDARD LIFE INSURANCE COMPANY | 385 | $102K |
| Vision | RELIANCE STANDARD LIFE INSURANCE COMPANY | 385 | $102K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 102 | $30K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 95 | $25K |
| Other(4 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 102 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 385 | — |
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.