| 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 BENEFIT PLANS CORPORATION | $18K | — | $18K | 2.11% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN-JOHNSON INSURANCE | 700 REGENT STREET MADISON, WI 53715 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | — | $4K | 6.46% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | PO BOX 9201, BLDG I SUITE 100 AUSTIN, TX 78766 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $3K | $3K | 5.01% |
| GIS BENEFITS INC3 Filed as: GIS OF WISCONSIN | PO BOX 901 NAPERVILLE, IL 60566 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 5.01% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN-JOHNSON INSURANCE | 700 REGENT STREET MADISON, WI 53715 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | PO BOX 9201, BLDG I SUITE 100 AUSTIN, TX 78766 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $1K | $1K | 5.00% |
| GIS BENEFITS INC3 Filed as: GIS OF WISCONSIN | PO BOX 901 NAPERVILLE, IL 60566 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 5.00% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN-JOHNSON INSURANCE | 700 REGENT STREET MADISON, WI 53715 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 14.50% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | PO BOX 9201, BLDG I SUITE 100 AUSTIN, TX 78766 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $887 | $887 | 5.00% |
| GIS BENEFITS INC3 Filed as: GIS OF WISCONSIN | PO BOX 901 NAPERVILLE, IL 60566 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $887 | — | $887 | 5.00% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN-JOHNSON INSURANCE | 700 REGENT STREET MADISON, WI 53715 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 9.00% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | PO BOX 9201, BLDG I SUITE 100 AUSTIN, TX 78766 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $868 | $868 | 5.01% |
| GIS BENEFITS INC3 Filed as: GIS OF WISCONSIN | PO BOX 901 NAPERVILLE, IL 60566 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $868 | — | $868 | 5.01% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN-JOHNSON INSURANCE | 700 REGENT STREET MADISON, WI 53715 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $106 | — | $106 | 10.01% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | PO BOX 9201, BLDG I SUITE 100 AUSTIN, TX 78766 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $53 | $53 | 5.00% |
| GIS BENEFITS INC3 Filed as: GIS OF WISCONSIN | PO BOX 901 NAPERVILLE, IL 60566 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $53 | — | $53 | 5.00% |
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 | 126 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 154 | $833K |
| Dental | RELIANCE STANDARD LIFE INSURANCE COMPANY | 80 | $68K |
| Vision | RELIANCE STANDARD LIFE INSURANCE COMPANY | 80 | $68K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 167 | $17K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 123 | $24K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 123 | $18K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 154 | $833K |
| Other(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 167 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 167 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.