| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 1515 WYNKOOP STREET, SUITE 200 DENVER, CO 80202 | KAISER FOUNDATION HEALTH PLAN OF COLORADO | $46K | $3K | $50K | 2.30% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62817 VIRGINIA CITY, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $14K | $1K | $15K | 8.45% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 6501 SOUTH FIDDLERS GREEN CIRCLE SUITE 100 GREENWOOD VILLAGE, CO 80111 | DELTA DENTAL OF COLORADO | $9K | — | $9K | 4.89% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 7050 ENGLEWOOD, CO 80155 | VISION SERVICE PLAN | $1K | — | $1K | 5.25% |
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 | 370 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 375 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF COLORADO | 394 | $2.2M |
| Dental | DELTA DENTAL OF COLORADO | 428 | $175K |
| Vision | VISION SERVICE PLAN | 229 | $22K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 372 | $175K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 372 | $175K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 372 | $175K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF COLORADO | 394 | $2.2M |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 372 | $175K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 428 | — |
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.
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.