| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $13K | — | $13K | 15.00% |
| COMPSYCH5 Filed as: COMPSYCH 35-3739783 | 455 N CITYFRONT PLAZA DR NBC TOWER CHICAGO, IL 60611 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $1K | $1K | 1.23% |
| PRUDENTIAL INSURANCE COMPANY5 Filed as: THE PRUDENTIAL INSURANCE 22-1211670 | P.O. BOX 7827 PHILADELPHIA, PA 19176 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $353 | $353 | 0.39% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $28 | $28 | 0.03% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | STANDARD INSURANCE COMPANY | $4K | $242 | $4K | 10.57% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 5.00% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | P.O. BOX 9201 AUSTIN, TX 78766 | STANDARD INSURANCE COMPANY | — | $1K | $1K | 3.00% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRIVNE, CA 92612 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $204 | $5K | 26.93% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRIVNE, CA 92612 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $118 | $2K | 10.75% |
| VOLUNTARY BENEFIT ADVISORS3 Filed as: VOLUNTARY BENEFIT ADVISORS, INC | 2400 MAIN ST SUITE 200 IRVINE, CA 92614 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $656 | $1 | $657 | 3.58% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $140 | — | $140 | 0.76% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN, INC. | PO BOX 9201 AUSTIN, TX 78766 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $140 | — | $140 | 0.76% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRIVNE, CA 92612 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $449 | $23 | $472 | 6.61% |
| VOLUNTARY BENEFIT ADVISORS3 Filed as: VOLUNTARY BENEFIT ADVISORS, INC | 2400 MAIN ST SUITE 200 IRVINE, CA 92614 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $239 | $2 | $241 | 3.38% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $39 | — | $39 | 0.55% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN, INC. | PO BOX 9201 AUSTIN, TX 78766 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $39 | — | $39 | 0.55% |
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 | 151 | 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) | 151 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | STANDARD INSURANCE COMPANY | 36 | $42K |
| Vision | STANDARD INSURANCE COMPANY | 36 | $0 |
| Life insurance(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 151 | $97K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 8 | $19K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 151 | $90K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 151 | $108K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 151 | — |
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.