| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COOK & ASSOCIATES INS BROKERS3 Filed as: COOK & ASSOC INS. BROKER | 700 BROADWAY STE 811 DENVER, CO 80203 | UNIMERICA INSURANCE COMPANY | $55K | — | $55K | 15.00% |
| EMPLOYEE BENEFIT MGMT SERVICES LLC5 Filed as: EMPLOYEE BENEFIT MGMT SERVICES | 2075 OVERLAND AVE BILLIINGS, MT 59104 | UNIMERICA INSURANCE COMPANY | $5K | — | $5K | 1.44% |
| COOK & ASSOCIATES INS BROKERS3 Filed as: COOK & ASSOCIATES | 700 BROADWAY, STE 811 DENVER, CO 80203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $13K | — | $13K | 4.58% |
| COOK & ASSOCIATES INS BROKERS3 Filed as: COOK & ASSOCIATES | 700 BROADWAY, STE 811 DENVER, CO 80203 | VISION SERVICE PLAN | $1K | — | $1K | 5.09% |
| COOK & ASSOCIATES INS BROKERS3 Filed as: COOK & ASSOCIATES | 700 BROADWAY, STE 811 DENVER, CO 80203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 15.00% |
| COOK & ASSOCIATES INS BROKERS3 Filed as: COOK & ASSOCIATES | 700 BROADWAY, STE 811 DENVER, CO 80203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 14.91% |
| COOK & ASSOCIATES INS BROKERS3 Filed as: COOK & ASSOCIATES | 700 BROADWAY, STE 811 DENVER, CO 80203 | DELTA DENTAL OF COLORADO | $4K | — | $4K | 33.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFIT MGMT SERVICES, INC EIN 81-0391256 TPA | Contract Administrator Service code 13 | — | $43K |
| EMPLOYEE BENEFIT MGMT SERVICES INC EIN 81-0391256 ACA SVC | Other services Service code 49 | — | $20K |
| DELTA DENTAL OF COLORADO EIN 84-0568337 DENTAL ADMIN | Contract Administrator Service code 13 | — | $13K |
| COFINITY EIN 20-1274723 PPO | Other services Service code 49 | — | $13K |
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 | 138 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 141 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF COLORADO | 443 | $13K |
| Vision | VISION SERVICE PLAN | 137 | $25K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 267 | $291K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 267 | $277K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 267 | $277K |
| Prescription drug | UNIMERICA INSURANCE COMPANY | 425 | $367K |
| Stop-loss / reinsurancereinsurance | UNIMERICA INSURANCE COMPANY | 425 | $367K |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 267 | $308K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 443 | — |
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.