| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHAMPION BENEFITS3 | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. | $51K | — | $51K | 63.50% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 14.98% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $2K | $3K | 12.51% |
| BENEFIT ADVISORS NETWORK LLC3 | 6830 COCHRAN ROAD SOLON, OH 44139 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $407 | $407 | 1.76% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | 9401 AMBERGLEN BOULEVARD, SUITE 100 BUILDING 1 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $74 | $74 | 0.32% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 15.00% |
| BENEFIT ADVISORS NETWORK LLC3 | 6830 COCHRAN ROAD SOLON, OH 44139 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $46 | $46 | 0.22% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 14.98% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $956 | $1K | $2K | 12.28% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | 9401 AMBERGLEN BOULEVARD, SUITE 100 BUILDING 1 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $410 | $410 | 2.14% |
| BENEFIT ADVISORS NETWORK LLC3 | 6830 COCHRAN ROAD SOLON, OH 44139 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $348 | $348 | 1.82% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 24.88% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $430 | $79 | $509 | 5.89% |
| BENEFIT ADVISORS NETWORK LLC3 | 6830 COCHRAN ROAD SOLON, OH 44139 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $138 | $138 | 1.60% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | 9401 AMBERGLEN BOULEVARD, SUITE 100 BUILDING 1 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $24 | $24 | 0.28% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 24.98% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $354 | $89 | $443 | 6.25% |
| BENEFIT ADVISORS NETWORK LLC3 | 6830 COCHRAN ROAD SOLON, OH 44139 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $105 | $105 | 1.48% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | 9401 AMBERGLEN BOULEVARD, SUITE 100 BUILDING 1 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $26 | $26 | 0.37% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $286 | — | $286 | 15.00% |
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 | 104 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. | 209 | $80K |
| Vision | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. | 209 | $80K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 123 | $21K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 65 | $19K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 59 | $23K |
| Other(3 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 167 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 209 | — |
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.