| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PROVIDENCE BENEFITS SOLUTIONS LLC3 Filed as: PROVIDENCE BENEFIT SOLUTIONS, LLC | 3401 W CYPRESS ST STE 103 TAMPA, FL 33607 | BLUE CROSS BLUE SHIELD OF FLORIDA | $20K | — | $20K | 5.00% |
| EXCALIBUR FINANCIAL GROUP3 | 302 KNIGHTS RUN AVE STE 110 TAMPA, FL 33602 | BLUE CROSS BLUE SHIELD OF FLORIDA | $15K | — | $15K | 5.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC | 422 WAUPONSEE ST MORRIS, IL 60450 | AMERITAS LIFE INSURANCE CORP | — | $663 | $663 | 1.68% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | 9401 AMBERGLEN BLVD BLD 1 STE 100 AUSTIN, TX 78729 | RELAINCE STANDARD LIFE INSURANCE COMPANY | — | $592 | $592 | 5.00% |
| GROUP INSURANCE SERIVES INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELAINCE STANDARD LIFE INSURANCE COMPANY | $592 | — | $592 | 5.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS OF FLORIDA, INC | 9500 KOGER BLVD STE 111 ST PETERSBURG, FL 33702 | RELAINCE STANDARD LIFE INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
| MCGEE JR., GERALD M3 | 3657 RICHMOND STREET JACKSONVILLE, FL 32205 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $6K | — | $6K | 50.00% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | 9401 AMBERGLEN BLVD BLVD 1 STE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $572 | $572 | 5.00% |
| GROUP INSURANCE SERVICES INC, METT,3 | 422 WAUPONSEE STREET MORRIS, FL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $572 | — | $572 | 5.00% |
| MCGEE JR., GERALD M3 | 3657 RICHMOND STREET JACKSONVILLE, FL 32205 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 15.00% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | 9401 AMBERGLEN BLVD BLVD 1 STE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $484 | $484 | 5.00% |
| GROUP INSURANCE SERVICES INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $484 | — | $484 | 5.00% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | 9401 AMBERGLEN BLVD BLGD 1 STE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPNAY | — | $320 | $320 | 5.00% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: METTILLE, MARK S C/O GROUP INSURACE | 422 WAUPONSEE ST. MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPNAY | $320 | — | $320 | 5.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS OF FLORIDA, INC. | 9500 KOGER BLVD STE 111 SAINT PETERSBURG, FL 33702 | RELIANCE STANDARD LIFE INSURANCE COMPNAY | $0 | $0 | $0 | 0.00% |
| MCGEE JR., GERALD M3 Filed as: MCGEE JR,. GERALD M | 3657 RICHMOND STREET JACKSONVILLE, FL 32205 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $246 | — | $246 | 14.98% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | 9401 AMBERGLEN BLVD BLD 1 STE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $82 | $82 | 4.99% |
| GROUP INSURANCE SERVICES INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $82 | — | $82 | 4.99% |
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 | 88 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 88 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | BLUE CROSS BLUE SHIELD OF FLORIDA | 97 | $708K |
| Dental | AMERITAS LIFE INSURANCE CORP | 165 | $40K |
| Vision | AMERITAS LIFE INSURANCE CORP | 165 | $40K |
| Life insurance | RELAINCE STANDARD LIFE INSURANCE COMPANY | 16 | $12K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 51 | $10K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPNAY | 40 | $6K |
| Other(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 120 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 165 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.