| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 | 3900 KINROSS LAKES PARKWAY SUITE 300 RICHFIELD, OH 44286 | UNITEDHEALTHCARE INSURANCE COMPANY | $0 | $20K | $20K | 2.09% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 | PO BOX 9021 AUSTIN, TX 78766 | METROPOLITAN LIFE INSURANCE COMPANY | $14K | $4K | $18K | 20.84% |
| ASSUREDPARTNERS3 | 3900 KINROSS LAKES PARKWAY SUITE 300 RICHFIELD, IL 44286 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | $2K | $3K | 3.32% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $894 | $894 | 1.03% |
| ASSUREDPARTNERS3 | 285 COZZINS STREET COLUMBUS, OH 43215 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $17 | $17 | 0.02% |
| ASSUREDPARTNERS3 | 3900 KINROSS LAKES PARKWAY SUITE 300 RICHFIELD, TX 44286 | METLIFE PA TRUST | $5K | $0 | $5K | 15.00% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMIN., INC. | PO BOX 9201 AUSTIN, TX 78766 | METLIFE PA TRUST | $0 | $3K | $3K | 10.01% |
| GIS NATIONAL3 | 9500 KOGER AVENUE, SUITE 200 SAINT PETERSBURG, FL 33702 | METLIFE PA TRUST | $2K | $0 | $2K | 6.26% |
| ASSUREDPARTNERS3 | 285 COZZINS STREET COLUMBUS, OH 43215 | METLIFE PA TRUST | $1K | $0 | $1K | 3.75% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET SUITE 300 MORRIS, IL 60450 | METLIFE PA TRUST | $287 | $0 | $287 | 0.91% |
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 | 105 | 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) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 84 | $954K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 128 | $87K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 128 | $87K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 128 | $87K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 128 | $87K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 128 | $87K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 84 | $954K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 128 | $118K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 128 | — |
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.