| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RUSSEL J CARPENTIERI3 Filed as: RUSSEL J. CARPENTIERI | 500 OCEAN DR APT 9ED JUNO BEACH, FL 33408 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $66K | — | $66K | 14.90% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NY, INC | 1133 WESTCHESTER AVE. STE N136 WHITE PLAINS, NY 10604 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $3K | — | $3K | 6.63% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES | 1133 WESTCHESTER AVE. STE N136 WHITE PLAINS, NY 10604 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | — | $1K | 2.47% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | — | $4K | 9.50% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK, INC. | 1133 WESTCHESTER AVE SUITE N-136 WHITE PLAINS, NY 10604 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 3.00% |
| ADMINISTRATORS, INC, BOON-CHAPMAN B3 Filed as: ADMINISTRATORS, INC. BOON-CHAPMAN | 9401 AMBERGLEN BLVD. SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | -$97 | -$97 | -0.22% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | $619 | $5K | 14.97% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK, INC. | 1133 WESTCHESTER AVE. STE N136 WHITE PLAINS, NY 10604 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 5.45% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP OF WI LLC | 1200 N. MAYFAIR RD. SUITE 100 MILWAUKEE, WI 53226 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $619 | $619 | 1.80% |
| ADMINISTRATORS, INC, BOON-CHAPMAN B3 Filed as: ADMINISTRATORS, INC BOON-CHAPMAN | 9401 AMBERGLEN BLVD. SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | -$135 | -$135 | -0.39% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | $504 | $5K | 14.47% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK, INC. | 1133 WESTCHESTER AVE SUITE N-136 WHITE PLAINS, NY 10604 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 5.28% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP OF WI LLC | 1200 N. MAYFAIR RD. SUITE 100 MILWAUKEE, WI 53226 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $504 | $504 | 1.54% |
| ADMINISTRATORS, INC, BOON-CHAPMAN B3 Filed as: ADMINISTRATORS, INC. BOON-CHAPMAN | 9401 AMBERGLEN BLVD. SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | -$142 | -$142 | -0.44% |
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 | 424 | 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) | 424 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 546 | $442K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 639 | $50K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 546 | $442K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 546 | $442K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 546 | $442K |
| Other(4 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 546 | $554K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 639 | — |
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.