| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKER INC | 160 FEDERAL ST - FL 2 BOSTON, MA 02110 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $28K | — | $28K | 6.16% |
| GBS BENEFITS INC3 | 2040 TERRY STREET LONGMONT, CO 80501 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $12K | — | $12K | 2.69% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE & FIN SERVICE | 12404 PARK CENTRAL DR - STE 400S DALLAS, TX 75251 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $5K | $5K | 1.07% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERGARE INC | 160 FEDERAL ST-FL 2 BOSTON, MA 02110 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | — | $3K | 4.11% |
| SELMAN & COMPANY, LLC3 Filed as: SELMAN & COMPANY LLC | 1 INTEGRITY PKWY CLEVELAND, OH 44143 | PRINCIPAL LIFE INSURANCE COMPANY | — | $2K | $2K | 3.20% |
| GBS BENEFITS INS AGENCY3 Filed as: GBS COLORADO LLC | 2040 TERRY ST - STE 101 LONGMONT, CO 80501 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | — | $1K | 1.99% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS & FINANCIAL SRVCS | 12404 PARK CENTRAL DR-STE 4005 DALLAS, TX 75251 | PRINCIPAL LIFE INSURANCE COMPANY | — | $732 | $732 | 1.00% |
| RSC INSURANCE BROKERAGE INC3 | 1750 S HARBOR WAY-STE 330 PORTLAND, OR 97201 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 7.87% |
| GBS BENEFITS INS AGENCY3 Filed as: GBS COLORADO LLC | 2040 TERRY STREET LONGMONT, CO 80501 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $560 | $354 | $914 | 3.48% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSRANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $280 | $280 | 1.07% |
| LEAVITT GROUP3 Filed as: LEAVITT GROUP INSURANCE ADVISORS | 560 S 300 E-STE 150 SALT LAKE CITY, UT 84111 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $177 | $177 | 0.67% |
| RSC INSURANCE BROKERAGE INC3 | 1750 S HARBOR WAY-STE 330 PORTLAND, OR 97201 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 7.66% |
| GBS BENEFITS INS AGENCY3 Filed as: GBS COLORADO LLC | 2040 TERRY STREET LONGMONT, CO 80501 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $438 | $342 | $780 | 4.16% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $219 | $219 | 1.17% |
| LEAVITT GROUP3 Filed as: LEAVITT GROUP INSURANCE ADVISORS | 560 S 300 E - SUITE 150 SALT LAKE CITY, UT 84111 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $171 | $171 | 0.91% |
| RSC INSURANCE BROKERAGE INC3 | 1750 S HARBOR WAY-STE 330 PORTLAND, OR 97201 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $999 | — | $999 | 7.89% |
| GBS BENEFITS INS AGENCY3 Filed as: GBS COLORADO LLC | 2040 TERRY ST LONGMONT, CO 80501 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $268 | $215 | $483 | 3.81% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $134 | $134 | 1.06% |
| LEAVITT GROUP3 Filed as: LEAVITT GROUP INSURANCE ADVISORS | 560 S 300 E-STE 150 SALT LAKE CITY, UT 84111 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $107 | $107 | 0.84% |
| RSC INSURANCE BROKERAGE INC3 | 1750 S HARBOR WAY-STE 330 PORTLAND, OR 97201 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $777 | — | $777 | 7.72% |
| GBS BENEFITS INS AGENCY3 Filed as: GBS COLORADO LLC | 2040 TERRY ST LONGMONT, CO 80501 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $230 | $143 | $373 | 3.70% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $115 | $115 | 1.14% |
| LEAVITT GROUP3 Filed as: LEAVITT GROUP INSURANCE ADVISORS | 560 S 300 E -STE 150 SALT LAKE CITY, UT 84111 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $72 | $72 | 0.72% |
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 | 149 | 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) | 150 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 148 | $448K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 209 | $73K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 209 | $73K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 149 | $29K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 149 | $13K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 149 | $26K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 149 | $29K |
| 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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.