| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURED EQUITY MANAGEMENT CORP3 Filed as: ASSURED EQUITY MANAGEMENT CORPORATI | 1800 GLENARM PL., #900 DENVER, CO 80202 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $12K | $0 | $12K | 10.00% |
| OPTIO LLC3 | 8547 E ARAPAHOE RD GREENWOOD VILLAGE, CO 80112 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $743 | $0 | $743 | 2.17% |
| JACQUELINE BARTHELEMY3 Filed as: JACQUELINE MARIE STUEMKY | 10208 MIDDLE DARLEEN LEANDER, TX 78641 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $701 | $1 | $702 | 2.05% |
| ASSURED EQUITY MANAGEMENT CORP3 Filed as: ASSURED EQUITY MANAGEMENT | 1800 GLENARM #900 DENVER, CO 80202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $605 | $0 | $605 | 1.77% |
| MELISSA A KOLL3 Filed as: MELISSA A. KOLL | 216 CLIMAX DRIVE DILLON, CO 80435 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $346 | $1 | $347 | 1.01% |
| KENNA (VAN PELT) ROTERT3 | EMPLOYER PLAN SERVICES 4000 HOUSE AVENUE CHEYENNE, WY 82001 | VISION SERVICES PLAN | $4K | $0 | $4K | 14.19% |
| PEAK1 ADMINISTRATION5 | 608 NORTHWEST BLVD, SUITE 200 COEUR DALENE, ID 83814 | VISION SERVICES PLAN | $2K | $0 | $2K | 6.08% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ASSURED EQUITY MANAGEMENT CORP BROKER | Insurance agents and brokers Service code 22 | 1800 GLENARM PL., #900 DENVER, CO 80202 | $59K |
| CIGNA HEALTH AND LIFE INSURANCE EIN 59-1031071 ADMINISTRATOR | Claims processing; Direct payment from the plan; Contract Administrator; Float revenue; Other services; Participant communication; Non-monetary compensation Service code 12 | — | $33K |
| CIGNA HEALTH & LIFE INSURANCE CO | Contract Administrator; Named fiduciary; Direct payment from the plan; Non-monetary compensation; Claims processing; Float revenue; Other services; Participant communication Service code 12 | — | $7 |
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 | 281 | 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) | 281 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICES PLAN | 184 | $32K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 269 | $123K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 269 | $123K |
| Long-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 269 | $158K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 269 | — |
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.