| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | P O BOX 3727 NORFOLK, VA 23514 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 14.32% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $540 | $683 | $1K | 7.70% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 | 9401 AMBERGLEN BLVD SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $522 | $522 | 3.29% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: J SMITH LANIER AND CO | 11330 LAKEFIELD DRIVE SUITE 100 DULUTH, GA 30097 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $195 | — | $195 | 1.23% |
| USI INSURANCE SERVICES LLC3 | P O BOX 3727 NORFOLK, VA 23514 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 13.71% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $385 | $228 | $613 | 5.39% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 | 9401 AMBERGLEN BLVD SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $347 | $347 | 3.05% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $184 | — | $184 | 1.62% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: J SMITH LANIER AND CO | 11330 LAKEFIELD DRIVE SUITE 100 DULUTH, GA 30097 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $147 | — | $147 | 1.29% |
| USI INSURANCE SERVICES LLC3 | P O BOX 3727 NORFOLK, VA 23514 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 13.69% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $361 | $235 | $596 | 5.45% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 | 9401 AMERGLEN BLVD SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $335 | $335 | 3.06% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $186 | — | $186 | 1.70% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: J SMITH LANIER & CO | 11330 LAKEFIELD DRIVE SUITE 100 DULUTH, GA 30097 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $142 | — | $142 | 1.30% |
| USI INSURANCE SERVICES LLC3 | P O BOX 3727 NORFOLK, VA 23514 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $900 | — | $900 | 13.81% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $225 | $112 | $337 | 5.17% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | 9401 AMBERGLEN BLVD SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $100 | $101 | $201 | 3.08% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $101 | — | $101 | 1.55% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: J SMITH LANIER AND CO | 11330 LAKEFIELD DRIVE SUITE 100 DULUTH, GA 30097 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $78 | — | $78 | 1.20% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $217 | $123 | $340 | 7.83% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: J SMITH LANIER AND CO | 11330 LAKEFIELD DRIVE SUITE 100 DULUTH, GA 30097 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $57 | — | $57 | 1.31% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| USI INSURANCE SERVICES BROKER | Insurance services; Insurance agents and brokers Service code 22 | P O BOX 3727 NORFOLK, VA 23514 | $34K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIMS ADMIN | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Plan Administrator; Contract Administrator Service code 12 | — | $24K |
| CIGNA | Named fiduciary; Contract Administrator; Non-monetary compensation; Claims processing; Participant communication; Float revenue; Direct payment from the plan; Other services Service code 12 | — | $0 |
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 | 103 | 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) | 103 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 103 | $209K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 43 | $7K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 89 | $11K |
| Other(3 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 82 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 103 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.