| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SVCS INC | PO BOX 632886 CINCINNATI, OH 45263 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 3.97% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 3.94% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES | PO BOX 632886 CINCINNAT, OH 45263 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 7.97% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 4.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SVCS INC | PO BOX 632886 CINCINNATI, OH 45263 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 5.53% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 4.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 452632886 | VISION SERVICE PLAN | $4K | — | $4K | 12.28% |
| LEAVITT GROUP3 Filed as: CIA - LEAVITT INSURANCE AGENCY, INC | PO BOX 5002 ALAMOSA, CO 811017012 | VISION SERVICE PLAN | — | -$2 | -$2 | -0.01% |
| SHERRY TURNER3 Filed as: SHERRY TURNER LLC | 1548 G STREET UNIT 1 SALIDA, CA 81201 | CONTINENTAL AMERICAN INSURANCE COMPANY | $3K | — | $3K | 15.25% |
| ROGER CURTIS POWELL3 Filed as: ROGER POWELL | 550 LIBERTY ST. APT 501 BRIANTREE, MA 02184 | CONTINENTAL AMERICAN INSURANCE COMPANY | $815 | — | $815 | 3.55% |
| BUSINESS DELIVERY SOLUTIONS, LLC3 Filed as: BUSINESS DELIVERY SOLUTIONS LLC | UNKNOWN PUEBLO WEST, CO 81007 | CONTINENTAL AMERICAN INSURANCE COMPANY | $604 | — | $604 | 2.63% |
| KEVIN NAUMANN3 | 4018 GOODNIGHT AVENUE PUEBLO, CO 81005 | CONTINENTAL AMERICAN INSURANCE COMPANY | $411 | — | $411 | 1.79% |
| FRED H STREIFF3 Filed as: FRED STREIFF | 33000 VISTA WEST DRIVE TRINIDAD, CO 81082 | CONTINENTAL AMERICAN INSURANCE COMPANY | $67 | — | $67 | 0.29% |
| ZAKERY HARLOW3 | 3204 N. ACADEMY BLVD. SUITE 130 COLORADO SPRINGS, CO 80917 | CONTINENTAL AMERICAN INSURANCE COMPANY | $25 | — | $25 | 0.11% |
| THOMAS J PITZENBERGER3 Filed as: THOMAS PITZENBERGER | 1501 SUGARLAND PARKWAY PLEASANT HILL, MO 64080 | CONTINENTAL AMERICAN INSURANCE COMPANY | $22 | — | $22 | 0.10% |
| CLINT WEIGHT3 | 745 S 180 WEST SALEM, UT 84653 | CONTINENTAL AMERICAN INSURANCE COMPANY | $10 | — | $10 | 0.04% |
| NIKKI KERR3 | PO BOX 7714 PUEBLO WEST, CO 81007 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4 | — | $4 | 0.02% |
| JOSE DE LOS SANTOS III3 | 155 INVERNESS DRIVE WEST SUITE 300 ENGLEWOOD, CO 80112 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| TINA WAY3 Filed as: TINA R WAY | 155 INVERNESS DRIVE WEST SUITE 300 ENGLEWOOD, CO 80122 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIM PROCESSING | Claims processing Service code 12 | — | $64K |
| DELTA DENTAL EIN 83-4416613 CONTRACT ADMINISTRATION | Contract Administrator Service code 13 | — | $16K |
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 | 588 | 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) | 588 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 384 | $34K |
| Life insurance | STANDARD INSURANCE COMPANY | 588 | $85K |
| Short-term disability(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 588 | $66K |
| Long-term disability | STANDARD INSURANCE COMPANY | 588 | $44K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 588 | — |
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.