| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RANDY M GOLDSTEIN3 | PO BOX 100082 DENVER, CO 80250 | HMO COLORADO INC | $13K | — | $13K | 1.99% |
| CRS GROUP BENEFITS INC3 | 6600 E HAMPDEN AVE STE 200 DENVER, CO 80224 | HMO COLORADO INC | $12K | — | $12K | 1.96% |
| WORKSITE BENEFIT SOLUTIONS INC3 Filed as: WORKSITE BENEFIT SOLUTIONS LLC | 12209 W BURGUNDY AVE LITTLETON, CO 80127 | AMERICAN FIDELITY ASSURANCE CO | — | — | $0 | 0.00% |
| CRS GROUP BENEFITS INC3 | 6600 E HAMPDEN AVE STE 200 DENVER, CO 80224 | DELTA DENTAL OF COLORADO | $538 | — | $538 | 2.57% |
| RANDY M GOLDSTEIN3 | PO BOX 100082 DENVER, CO 80250 | DELTA DENTAL OF COLORADO | $136 | — | $136 | 0.65% |
| RANDY M GOLDSTEIN3 | PO BOX 100082 DENVER, CO 80250 | THE LINCOLN NATIONAL LIFE INSURANCE CO | $740 | — | $740 | 6.19% |
| VALERIE JEFFERS3 | 2274 THOMAS CT PARKER, CO 80138 | THE LINCOLN NATIONAL LIFE INSURANCE CO | $627 | — | $627 | 5.24% |
| RANDY M GOLDSTEIN3 | PO BOX 100082 DENVER, CO 80250 | UNITED DENTAL CARE OF COLORADO | $660 | — | $660 | 6.52% |
| CRS GROUP BENEFITS INC3 | 6600 E HAMPDEN AVE STE 200 DENVER, CO 80224 | UNITED DENTAL CARE OF COLORADO | $351 | — | $351 | 3.47% |
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 | 148 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 148 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HMO COLORADO INC | 83 | $629K |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF COLORADO | 93 | $31K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE CO | 146 | $12K |
| Short-term disability | AMERICAN FIDELITY ASSURANCE CO | 46 | $63K |
| Long-term disability | AMERICAN FIDELITY ASSURANCE CO | 46 | $63K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 146 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.