| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PROVIDENCE BENEFITS SOLUTIONS LLC3 Filed as: PROVIDENCE BENEFIT SOLUTIONS | 3401 W CYPRESS STREET SUITE 103 TAMPA, FL 33607 | BLUE CROSS BLUE SHIELD OF FLORIDA | $23K | — | $23K | 6.00% |
| PROVIDENCE BENEFITS SOLUTIONS LLC3 Filed as: PROVIDENCE BENEFIT SOLUTIONS | 3401 W CYPRESS STREET SUITE 103 TAMPA, FL 33607 | HEALTH OPTIONS, INC | $16K | — | $16K | 6.00% |
| RONALD WAYNE MOORE3 Filed as: RONALD W MOORE | 3401 W CYPRESS STREET SUITE 103 TAMPA, FL 33607 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | — | $6K | 12.00% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $1K | $3K | 7.20% |
| PROVIDENCE BENEFITS SOLUTIONS LLC3 | 3401 W CYPRESS STREET SUITE 103 TAMPA, FL 33607 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | $394 | $5K | 16.33% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 5.00% |
| PROVIDENCE BENEFITS SOLUTIONS LLC3 | 3401 W CYPRESS STREET SUITE 103 TAMPA, FL 33607 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | $221 | $3K | 16.27% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $871 | — | $871 | 5.00% |
| PROVIDENCE BENEFITS SOLUTIONS LLC3 | 3401 W CYPRESS STREET SUITE 103 TAMPA, FL 33607 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 25.22% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $299 | $299 | 2.31% |
| BOON CHAPMAN BNFT ADMNSTRS INC3 | PO BOX 9039 AUSTIN, TX 78766 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $293 | $293 | 2.27% |
| PROVIDENCE BENEFITS SOLUTIONS LLC3 | 3401 W CYPRESS STREET SUITE 103 TAMPA, FL 33607 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $147 | $2K | 16.26% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $585 | — | $585 | 5.00% |
| PROVIDENCE BENEFITS SOLUTIONS LLC3 | 3401 W CYPRESS STREET SUITE 103 TAMPA, FL 33607 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 20.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $336 | — | $336 | 5.00% |
| GIS BENEFITS INC3 Filed as: GIS | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $96 | $96 | 1.43% |
| PROVIDENCE BENEFITS SOLUTIONS LLC3 | 3401 W CYPRESS STREET SUITE 103 TAMPA, FL 33607 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 20.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $325 | — | $325 | 5.00% |
| GIS BENEFITS INC3 Filed as: GIS | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $125 | $125 | 1.92% |
| PROVIDENCE BENEFITS SOLUTIONS LLC3 | 3401 W CYPRESS STREET SUITE 103 TAMPA, FL 33607 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $450 | $42 | $492 | 16.41% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $150 | — | $150 | 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 | 107 | 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) | 107 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF FLORIDA | 65 | $647K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 113 | $46K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 113 | $46K |
| Life insurance(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 288 | $43K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 37 | $12K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 50 | $17K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF FLORIDA | 65 | $647K |
| Other(5 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 288 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 288 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.