| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $17K | $17K | 13.16% |
| ACRISURE LLC3 Filed as: ACRISURE SE PARTNERS INS SVCS. | 1317 CITIZENS BOULEVARD LEESBURG, FL 34748 | PRINCIPAL LIFE INSURANCE COMPANY | $5K | — | $5K | 4.36% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | PRINCIPAL LIFE INSURANCE COMPANY | $5K | — | $5K | 4.33% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL IOWA, LLC | 212 BRADY STREET, SUITE 4B DAVENPORT, IA 52801 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | — | $2K | 1.43% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL LIMITED | 150 NORTH RIVERSIDE PLAZA SUITE 1700 CHICAGO, IL 60606 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $2K | $2K | 1.41% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | $0 | $5K | 12.87% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $0 | $2K | 4.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL IOWA, LLC | 15162 COLLECTIONS CENTER DRIVE CHICAGO, IL 60693 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $752 | $0 | $752 | 2.08% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | METLIFE LEGAL PLANS | $220 | $0 | $220 | 10.16% |
| GIS BENEFITS INC3 Filed as: GIS OF ILLINOIS | 422 WAUPONSEE STREET MORRIS, IL 60450 | METLIFE LEGAL PLANS | $280 | $0 | $280 | 16.82% |
| ACRISURE LLC3 Filed as: ACRISURE GREAT LAKES PARTNERS INS | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | METLIFE LEGAL PLANS | $137 | $0 | $137 | 8.23% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMIN, INC. | PO BOX 9201, BUILDING I SUITE 100 AUSTIN, TX 78766 | METLIFE LEGAL PLANS | $0 | $84 | $84 | 5.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL IOWA, LLC | 212 BRADY STREET, SUITE 4B DAVENPORT, IA 52801 | METLIFE LEGAL PLANS | $29 | $0 | $29 | 1.74% |
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 | 113 | 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) | 113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 217 | $126K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 217 | $126K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 217 | $162K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 217 | $126K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 217 | $126K |
| Other(4 contracts, 3 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 217 | $166K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 217 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.