| 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. | $26K | — | $26K | 2.90% |
| FIRST STATE FINANCIAL GROUP3 | 902 E MCCORD ST. CENTRALIA, IL 62801 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | — | $7K | 9.11% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | PRINCIPAL LIFE INSURANCE COMPANY | — | $6K | $6K | 8.01% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 NORTH SHORE DRIVE STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $6K | $923 | $7K | 17.46% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $528 | $2K | 6.41% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 NORTH SHORE DRIVE STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | $506 | $5K | 16.52% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $289 | $2K | 5.87% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 NORTH SHORE DRIVE STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | $721 | $5K | 17.47% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $412 | $2K | 6.41% |
| DESSO HUEN FORMAN3 | 1702 COPPERFIELD CIR TALLAHASSEE, FL 32312 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $613 | — | $613 | 6.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $511 | $76 | $587 | 5.74% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 NORTH SHORE DR. STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $409 | — | $409 | 4.00% |
| DESSO HUEN FORMAN3 | 1702 COPPERFIELD CIR TALLAHASSEE, FL 32312 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $590 | — | $590 | 6.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $492 | $54 | $546 | 5.55% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 NORTH SHORE DR. STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $393 | — | $393 | 4.00% |
| SEUBERT & ASSOCIATES, INC.3 Filed as: SEUBERT & ASSOCIATES INC. | 225 NORTH SHORE DRIVE STE 300 PITTSBURGH, PA 15212 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $658 | $119 | $777 | 17.72% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $219 | $68 | $287 | 6.55% |
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 | 206 | 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) | 206 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HIGHMARK, INC. | 235 | $905K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 233 | $73K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 233 | $73K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 132 | $29K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 80 | $37K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 65 | $33K |
| Prescription drug | HIGHMARK, INC. | 225 | $269K |
| Other(4 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 132 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 235 | — |
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.