| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 4600 SOUTH ULSTER STREET SUITE 1200 DENVER, CO 80237 | UNITEDHEALTHCARE INSURANCE COMPANY | $878 | $0 | $878 | 0.12% |
| BOK FINANCIAL INSURANCE3 Filed as: BOK FINANCIAL INSURANCE, INC. | 1600 BROADWAY DENVER, CO 80202 | UNITEDHEALTHCARE INSURANCE COMPANY | $487 | $0 | $487 | 0.07% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $521 | $521 | 3.04% |
| USI INSURANCE SERVICES LLC3 | 1600 NORTH BROADWAY, 9TH FLOOR DENVER, CO 80264 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $379 | $0 | $379 | 2.21% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $535 | $0 | $535 | 6.37% |
| USI INSURANCE SERVICES LLC3 | 2375 EAST CAMELBACK ROAD, SUITE 250 PHOENIX, AZ 85016 | VISION SERVICE PLAN | $69 | $0 | $69 | 0.82% |
| USI INSURANCE SERVICES LLC3 | 1600 NORTH BROADWAY, 9TH FLOOR DENVER, CO 80264 | UNUM INSURANCE COMPANY | $507 | $0 | $507 | 10.45% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R. NELLIGAN AND ASSOCIATES | 1933 STATE ROUTE 35, SUITE 368 WALL, NJ 07719 | UNUM INSURANCE COMPANY | $0 | $244 | $244 | 5.03% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | UNUM INSURANCE COMPANY | $0 | $146 | $146 | 3.01% |
| USI INSURANCE SERVICES LLC3 | 1600 NORTH BROADWAY, 9TH FLOOR DENVER, CO 80264 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $546 | $0 | $546 | 21.49% |
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 | 75 | 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) | 75 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 75 | $705K |
| Vision | VISION SERVICE PLAN | 69 | $8K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 75 | $17K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 75 | $17K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 75 | $17K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 75 | $705K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 75 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 75 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.