| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GBS BENEFITS INS AGENCY3 Filed as: GBS COLORADO LLC | 2040 TERRY ST STE 101 LONGMONT, CO 80501 | PRINCIPAL LIFE INSURANCE COMPANY | $10K | — | $10K | 10.09% |
| LEAVITT GROUP3 Filed as: LEAVITT GROUP AGENCY ASSOCIATION | PO BOX 130 CEDAR CITY, UT 84721 | PRINCIPAL LIFE INSURANCE COMPANY | — | $863 | $863 | 0.91% |
| GBS BENEFITS INS AGENCY3 Filed as: GBS COLORADO LLC | 2040 TERRY ST STE 101 LONGMONT, CO 80501 | DELTA DENTAL | $7K | — | $7K | 10.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ROCKY MOUNTAIN HOSPITAL & MEDICAL EIN 84-0747736 CLAIMS PROCESSOR | Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $189K |
| CENTERSTONE INSURANCE EIN 95-4018229 SERVICE PROVIDER | Non-monetary compensation; Other commissions; Insurance agents and brokers Service code 22 | — | $0 |
| GBS COLORADO LLC EIN 81-3387763 SALES AND BASE COMMISSION | Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $0 |
| INGENIORX, INC. EIN 82-3062245 PRESCRIPTION DRUG | Float revenue; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | — | $0 |
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 | 116 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 116 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL | 205 | $71K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 211 | $95K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 211 | $95K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 211 | $95K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 211 | $95K |
| Stop-loss / reinsurancereinsurance | ROCKY MOUNTAIN HOPSITAL & MEDICAL SERVICE, INC. | 174 | $342K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 211 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.