| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RANDY M GOLDSTEIN3 | PO BOX 100082 DENVER, CO 80250 | HMO COLORADO INC | $26K | — | $26K | 3.55% |
| BRIAN K BURNHAM3 | 12209 W BURGANDY AVE LITTLETON, CO 80127 | AMERICAN FIDELITY ASSURANCE COMPANY | $9K | — | $9K | 22.66% |
| USI INSURANCE SERVICES LLC3 Filed as: USI OF SOUTHERN CALIFORNIA INS SERV | 21700 OXNARD ST #1200 WOODLAND HILLS, CA 91367 | AMERICAN FIDELITY ASSURANCE COMPANY | $2K | — | $2K | 5.02% |
| RANDY M GOLDSTEIN3 Filed as: RANDY GOLDSTEIN | PO BOX 100082 DENVER, CO 80250 | DELTA DENTAL OF COLORADO | $221 | — | $221 | 1.02% |
| RANDY M GOLDSTEIN3 | PO BOX100082 DENVER, CO 80250 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 10.87% |
| RANDY M GOLDSTEIN1 Filed as: RANDY GOLDSTEIN | PO BOX 100082 DENVER, CO 80250 | UNITED DENTAL CARE OF COLORADO INC | $1K | — | $1K | 10.01% |
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 | 189 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 189 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HMO COLORADO INC | 110 | $727K |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF COLORADO | 59 | $34K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 190 | $14K |
| Short-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 45 | $38K |
| Long-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 45 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 190 | — |
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.