| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 1575 NORTHSIDE DRIVE NW BUILDING 100, SUITE 10 ATLANTA, GA 30318 | HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. | $53K | $2K | $55K | 4.07% |
| JOHNSON AND BRYAN INC3 Filed as: JOHNSON AND BRYAN, INC. | 1575 NORTHSIDE DRIVE BUILDING 100, SUITE 100 ATLANTA, GA 30318 | HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. | $0 | $2K | $2K | 0.13% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | AMERITAS LIFE INSURANCE CORPORATION | $0 | $1K | $1K | 1.08% |
| USI INSURANCE SERVICES LLC3 | PO BOX 20138 ATLANTA, GA 30325 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $8K | $0 | $8K | 15.00% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 | 9401 AMBERGLEN BOULEVARD BUILDING 1, SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | $3K | $3K | 5.00% |
| MARK S METTILLE3 Filed as: MARK S. METTILLE | 107 CANDELIGHT LANE MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | $0 | $3K | 4.73% |
| MARK S METTILLE3 Filed as: MARK S. METTILLE | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $146 | $0 | $146 | 0.27% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 | PO BOX 9201 AUSTIN, TX 78766 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $954 | $5K | 24.63% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $882 | $882 | 4.50% |
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) | HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. | 154 | $1.3M |
| Dental | AMERITAS LIFE INSURANCE CORPORATION | 363 | $97K |
| Vision | AMERITAS LIFE INSURANCE CORPORATION | 363 | $97K |
| Life insurance(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 321 | $73K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 107 | $53K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 107 | $53K |
| Prescription drug | HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. | 154 | $1.3M |
| Other(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 321 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 363 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.