| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 9605 S KINGSTON CT STE 150 ENGLEWOOD, CO 80112 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 11.99% |
| ACRISURE LLC3 | 9605 S KINGSTON CT STE 150 ENGLEWOOD, CO 80112 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 15.00% |
| ACRISURE LLC3 | 9605 S KINGSTON CT STE 150 ENGLEWOOD, CO 80112 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $992 | — | $992 | 15.00% |
| ROGERS BENEFIT GROUP INC4 Filed as: MICHAEL J ROGERS | PO BOX 853 GEORGETOWN, CO 80444 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $561 | — | $561 | 13.46% |
| BENEFIT HEALTH ADVISOR4 Filed as: BENEFIT HEALTH ADVISOR INC | 9605 S KINGSTON CT STE 150 ENGLEWOOD, CO 80112 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $180 | — | $180 | 4.32% |
| RAYMOND R. BLAZAK4 Filed as: RAYMOND R BLAZAK | 22419 E PLYMOUTH CIR AURORA, CO 80016 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $100 | — | $100 | 2.40% |
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 | 190 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 191 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 41 | $45K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 54 | $10K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 36 | $12K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 21 | $7K |
| Other | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | 14 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 54 | — |
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.