| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 NORTH SHORE DRIVE STE 300 PITTSBURGH, PA 15212 | HIGHMARK, INC. | $11K | — | $11K | 1.74% |
| DOUGLAS MOORE3 | 1712 MT. NEBO ROAD SEWICKLEY, PA 15413 | HIGHMARK, INC. | $10K | — | $10K | 1.59% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 NORTH SHORE DR. STE 300 PITTSBURGH, PA 15212 | PRINCIPAL LIFE INSURANCE COMPANY | $5K | — | $5K | 9.94% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $2K | $4K | 8.97% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 NORTH SHORE DRIVE STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 5.00% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 NORTH SHORE DRIVE STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 15.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $924 | — | $924 | 5.00% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 NORTH SHORE DRIVE STE 300 PITTSBURGH, PA 15212 | 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 | $643 | — | $643 | 5.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $366 | $67 | $433 | 5.92% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 NORTH SHORE DR. STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $293 | $61 | $354 | 4.84% |
| DESSO HUEN FORMAN3 | 1702 COPPERFIELD CIR TALLAHASSEE, FL 32312 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $243 | — | $243 | 3.32% |
| DIANA LEWIS3 Filed as: DIANA N LEWIS | 28059 US HIGHWAY 19 NORTH STE 201 CLEARWATER, FL 33761 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $196 | — | $196 | 2.68% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $270 | $46 | $316 | 5.85% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 NORTH SHORE DR. STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $216 | $41 | $257 | 4.76% |
| DESSO HUEN FORMAN3 | 1702 COPPERFIELD CIR TALLAHASSEE, FL 32312 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $200 | — | $200 | 3.70% |
| DIANA LEWIS3 Filed as: DIANA N LEWIS | 28059 US HIGHWAY 19 NORTH STE 201 CLEARWATER, FL 33761 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $124 | — | $124 | 2.30% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 NORTH SHORE DRIVE STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $459 | — | $459 | 15.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $153 | — | $153 | 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 | 167 | 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) | 167 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HIGHMARK, INC. | 195 | $632K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 196 | $47K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 196 | $47K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 196 | $65K |
| Short-term disability(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 196 | $70K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 33 | $13K |
| Prescription drug | HIGHMARK, INC. | 193 | $169K |
| Other(4 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 105 | $34K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 196 | — |
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."
No prospect flags tripped on this filing.