| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PEAK INC5 Filed as: PEAK BENEFITS | 6860 S. YOSEMITE CT. #2000 CENTENNIAL, CO 801121448 | HUMANA DENTAL INSURANCE COMPANY | $6K | — | $6K | 3.22% |
| PEAK INC3 Filed as: PEAK BENEFITS | 6860 S. YOSEMITE CT. #2000 CENTENNIAL, CO 801121448 | PRINCIPAL LIFE INSURANCE COMPANY | $12K | — | $12K | 9.33% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 ARGOURA RD ATTN STEFANIE FREED WESTLAKE VILLAGE, CA 913614026 | PRINCIPAL LIFE INSURANCE COMPANY | — | $4K | $4K | 3.24% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 6143 S. WILLOW DRIVE, #200 ATTN ACCOUNTING DEPT GREENWOOD VILLAGE, CO 801115116 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | — | $4K | 3.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SPECIALIZED INSURANCE GROUP EIN 45-0543296 INSURANCE AGENT | Custodial (securities) Service code 19 | 6860 S YOSEMITE CT. STE 2111 CENTENNIAL, CO 80112 | $43K |
| CYPRESS BENEFIT ADMINISTRATORS EIN 39-1997579 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | 5560 W. GRANDE MARKET DRIVE APPLETON, WI 54913 | $37K |
| CONNECTICUT GENERAL EIN 06-0303370 OTHER | Other fees Service code 99 | 900 COTTAGE GROVE ROAD HARTFORD, CT 06152 | $25K |
| AMERICAN HEALTH HOLDING EIN 31-1368946 OTHER | Other fees Service code 99 | PO BOX 6016 COLUMBUS, OH 43085 | $4K |
| WARNER PACIFIC EIN 95-3959252 INSURANCE AGENT | Custodial (securities) Service code 19 | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | $4K |
| BRIDGEHEALTH MEDICAL EIN 26-0804648 OTHER | Other fees Service code 99 | 6000 E EVANS AVE. STE 2-400 DENVER, CO 80222 | $91 |
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 | 141 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 141 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | MARLTON | 141 | $362K |
| Dental | HUMANA DENTAL INSURANCE COMPANY | 142 | $183K |
| Vision | HUMANA DENTAL INSURANCE COMPANY | 142 | $183K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 246 | $127K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 246 | $127K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 246 | $127K |
| Other | MEDICAL EXCESS INSURANCE SERVICES | 141 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 246 | — |
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.