| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN-JOHNSON INSURANCE | 740 REGENT ST SUITE 400 MADISON, WI 53715 | QUARTZ HEALTH PLANS BENEFIT CORPORATION | $15K | — | $15K | 2.42% |
| INGENIUM PRIME INC3 | PO BOX 259408 MADISON, WI 53725 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $175 | $1K | 5.79% |
| ADMINISTRATORS, INC, BOON-CHAPMAN B3 | 9401 AMBERGLEN BLVD AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | $918 | $918 | 4.15% |
| INGENIUM PRIME INC3 | PO BOCX 259408 MADISON, WI 53725 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 9.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $836 | $135 | $971 | 5.80% |
| ADMNISTRATORS, INC, BOON-CHAPMAN B3 | 9401 AMBERGLEN BLVD SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | $700 | $700 | 4.18% |
| INGENIUM PRIME INC3 Filed as: INGENIUM PRIME | PO BOX 259408 MADISON, WA 53725 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $818 | $129 | $947 | 5.79% |
| ADMINISTRATORS, INC, BOON-CHAPMAN B3 | 9401 AMBERGLEN BLVD SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $679 | — | $679 | 4.15% |
| INGENIUM PRIME INC3 | PO BOX 259408 MADISON, WI 53725 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $145 | — | $145 | 9.99% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $73 | $10 | $83 | 5.72% |
| ADMINISTRATORS, INC, BOON-CHAPMAN B3 | 9401 AMBERGLEN BLVD SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $62 | — | $62 | 4.27% |
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 | 104 | 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) | 104 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | QUARTZ HEALTH PLANS BENEFIT CORPORATION | 130 | $619K |
| Dental | RELIANCE STANDARD LIFE INSURANCE COMPANY | 149 | $61K |
| Vision | RELIANCE STANDARD LIFE INSURANCE COMPANY | 149 | $61K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 100 | $17K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 100 | $22K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 100 | $16K |
| Prescription drug | QUARTZ HEALTH PLANS BENEFIT CORPORATION | 130 | $619K |
| Other(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 100 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 149 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.