| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 | 435 NORTH WHITTINGTON PARKWAY SUITE 300 LOUISVILLE, KY 40222 | COMMUNITY INSURANCE COMPANY | $28K | $0 | $28K | 2.54% |
| SHAWAN MARQUIS AGENCY INC3 Filed as: SHAWAN-MARQUIS AGENCY, INC. | 110 EAST WILSON BRIDGE ROAD SUITE 260 COLUMBUS, OH 43085 | COMMUNITY INSURANCE COMPANY | $4 | $0 | $4 | 0.00% |
| ASSUREDPARTNERS3 | 435 NORTH WHITTINGTON PARKWAY SUITE 300 LOUISVILLE, KY 40222 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $10K | $0 | $10K | 10.44% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | $0 | $3K | 3.20% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN | 9401 AMBERGLEN BOULEVARD, SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | $286 | $286 | 0.29% |
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 | 101 | 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) | 101 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY INSURANCE COMPANY | 117 | $1.1M |
| Dental | RELIANCE STANDARD LIFE INSURANCE COMPANY | 116 | $98K |
| Vision | RELIANCE STANDARD LIFE INSURANCE COMPANY | 116 | $98K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 116 | $98K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 116 | $98K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 116 | $98K |
| Prescription drug | COMMUNITY INSURANCE COMPANY | 117 | $1.1M |
| Other(3 contracts, 3 carriers) | COMMUNITY INSURANCE COMPANY | 117 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 117 | — |
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.