| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MOUTAINSIDE INSURANCE MANAGEMENT3 | 2000 WEST 104TH AVENUE DENVER, CO 80234 | HCC LIFE INSURANCE COMPANY | $48K | — | $48K | 10.00% |
| MOUNTAINSIDE INSURANCE MANAGEMENT3 | PO BOX 100 EASTLAKE, CO 80614 | AMERICAN FIDELITY ASSURANCE COMPANY | $5K | — | $5K | 3.08% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $5K | — | $5K | 2.88% |
| CADA INSURANCE SERVICES INC3 | 290 SPEER BOULEVARD DENVER, CO 80203 | AMERICAN FIDELITY ASSURANCE COMPANY | $3K | — | $3K | 1.86% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $3K | — | $3K | 1.66% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P.O. BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $2K | — | $2K | 1.25% |
| COLORADO AUTO DEALERS ASSOCIATION3 | C/O MR TIM JACKSON EXEC DIR DENVER, CO 80203 | AMERICAN FIDELITY ASSURANCE COMPANY | — | $804 | $804 | 0.48% |
| CADA INSURANCE SERVICES INC3 | 290 SPEER BOULEVARD DENVER, CO 80203 | AMERICAN FIDELITY ASSURANCE COMPANY | $532 | — | $532 | 0.32% |
| MOUNTAINSIDE INSURANCE MANAGEMENT3 | PO BOX 100 EASTLAKE, CO 80614 | AMERICAN FIDELITY ASSURANCE COMPANY | $408 | — | $408 | 0.24% |
| MOUNTAINSIDE INSURANCE MANAGEMENT3 | PO BOX 100 EASTLAKE, CO 80614 | AMERICAN FIDELITY ASSURANCE COMPANY | $372 | — | $372 | 0.22% |
| MOUNTAINSIDE INSURANCE MANAGEMENT3 | PO BOX 100 EASTLAKE, CA 80614 | AMERICAN FIDELITY ASSURANCE COMPANY | $364 | — | $364 | 0.22% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $260 | — | $260 | 0.16% |
| CADA INSURANCE SERVICES INC3 | 290 SPEER BOULEVARD DENVER, CO 80203 | AMERICAN FIDELITY ASSURANCE COMPANY | $259 | — | $259 | 0.16% |
| CADA INSURANCE SERVICES INC3 | 290 SPEER BOULEVARD DENVER, CO 80203 | AMERICAN FIDELITY ASSURANCE COMPANY | $225 | — | $225 | 0.13% |
| MOUNTAINSIDE INSURANCE MANAGEMENT3 | PO BOX 100 EASTLAKE, CO 80614 | AMERICAN FIDELITY ASSURANCE COMPANY | $184 | — | $184 | 0.11% |
| COLORADO AUTO DEALERS ASSOCIATION3 | C/O MR TIM JACKSON EXEC DIR DENVER, CO 80203 | AMERICAN FIDELITY ASSURANCE COMPANY | — | $175 | $175 | 0.10% |
| CADA INSURANCE SERVICES INC3 | 290 SPEER BOULEVARD DENVER, CO 80203 | AMERICAN FIDELITY ASSURANCE COMPANY | $156 | — | $156 | 0.09% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $144 | — | $144 | 0.09% |
| COLORADO AUTO DEALERS ASSOCIATION3 | C/O TIM JACKSON EXEC DIR DENVER, CO 80203 | AMERICAN FIDELITY ASSURANCE COMPANY | — | $123 | $123 | 0.07% |
| MOUNTAINSIDE INSURANCE MANAGEMENT3 | PO BOX 100 EASTLAKE, CO 80614 | AMERICAN FIDELITY ASSURANCE COMPANY | $85 | — | $85 | 0.05% |
| COLORADO AUTO DEALERS ASSOCIATION3 | C/O MR TIM JACKSON EXEC DIR DENVER, CO 80203 | AMERICAN FIDELITY ASSURANCE COMPANY | — | $51 | $51 | 0.03% |
| COLORADO AUTO DEALERS ASSOCIATION3 | C/O MR TIM JACKSON EXEC DIR DENVER, CO 80203 | AMERICAN FIDELITY ASSURANCE COMPANY | — | $2 | $2 | 0.00% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | -$758 | — | -$758 | -0.45% |
| MOUNTAINSIDE INSURANCE MANAGEMENT3 | PO BOX 100 EASTLAKE, CO 80614 | DELTA DENTAL OF COLORADO | $12K | — | $12K | 13.78% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE | 12404 PARK CENTRAL DRIVE SUITE 400S DALLAS, TX 75251 | DELTA DENTAL OF COLORADO | $5K | — | $5K | 5.51% |
| MOUNTAINSIDE INSURANCE MANAGEMENT3 Filed as: MOUNTAINSIDE INSURANCE MANAGEMENT L | PO BOX 100 EASTLAKE, CO 80614 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
| MOUNTAINSIDE INSURANCE MANAGEMENT3 | PO BOX 100 EASTLAKE, CO 80614 | EMBER ASSURANCE, INC. | $1K | — | $1K | 15.06% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE | 12404 PARK CENTRAL DRIVE SUITE 400S DALLAS, TX 75251 | EMBER ASSURANCE, INC. | $538 | — | $538 | 6.03% |
| MOUNTAINSIDE INSURANCE MANAGEMENT3 Filed as: MOUNTAINSIDE INSURANCE MANAGEMENT L | PO BOX 100 EASTLAKE, CO 80614 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $228 | — | $228 | 9.98% |
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 | 134 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 135 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF COLORADO | 120 | $85K |
| Vision | EMBER ASSURANCE, INC. | 93 | $9K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 210 | $23K |
| Short-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 77 | $167K |
| Long-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 77 | $167K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 83 | $483K |
| Other(3 contracts, 2 carriers) | AMERICAN FIDELITY ASSURANCE COMPANY | 210 | $192K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 210 | — |
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.
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.