| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INS SERVICES | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | BLUE CROSS OF CALIFORNIA | $34K | — | $34K | 5.03% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INS SERVICES | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | $1K | $7K | 12.86% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $600 | $3K | 6.09% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 Filed as: BOON CHAPMAN BENEFIT ADMIN | PO BOX 9201 AUSTIN, TX 78706 | METROPOLITAN LIFE INSURANCE COMPANY | — | $2K | $2K | 3.97% |
| PATRICK KIRCHNER3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | BOON CHAPMAN BENEFIT ADMIN | $1K | $420 | $1K | 14.11% |
| GIS OF ILLINOIS3 Filed as: GIS BENEFITTS INC | 422 WAUPONSEE STREET MORRIS, IL 60450 | BOON CHAPMAN BENEFIT ADMIN | $521 | $112 | $633 | 6.04% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INS SERVICES | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | BOON CHAPMAN BENEFIT ADMIN | $454 | $142 | $596 | 5.68% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 Filed as: BOON CHAPMAN BENEFIT ADMIN | PO BOX 9201 AUSTIN, TN 78766 | BOON CHAPMAN BENEFIT ADMIN | — | $476 | $476 | 4.54% |
| PATRICK KIRCHNER3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $761 | $489 | $1K | 13.56% |
| GIS OF ILLINOIS3 Filed as: GIS BENEFITTS INC | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $461 | $101 | $562 | 6.09% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INS SERVICES | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | METROPOLITAN LIFE INSURANCE COMPANY | $326 | $152 | $478 | 5.18% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 Filed as: BOON CHAPMAN BENEFIT ADMIN | PO BOX 9201 AUSTIN, TX 78766 | METROPOLITAN LIFE INSURANCE COMPANY | — | $421 | $421 | 4.57% |
| PATRICK KIRCHNER3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | BOON CHAPMAN BENEFIT ADMIN | $2K | $259 | $2K | 31.09% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INS SERVICES | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | BOON CHAPMAN BENEFIT ADMIN | $863 | $117 | $980 | 13.40% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS | 422 WAUPONSEE STREET MORRIS, IL 60450 | BOON CHAPMAN BENEFIT ADMIN | $360 | $77 | $437 | 5.97% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 Filed as: BOON CHAPMAN BENEFIT ADMIN | PO BOX 9201 AUSTIN, TX 78766 | BOON CHAPMAN BENEFIT ADMIN | — | $329 | $329 | 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 | 143 | 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) | 143 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 76 | $677K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 175 | $55K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 175 | $55K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 175 | $55K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 175 | $55K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 76 | $677K |
| Other(4 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 175 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 175 | — |
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.