| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BOK FINANCIAL INSURANCE3 Filed as: BOK FINANCIAL INSURANCE SERVICE | 1600 N BROADWAY 9TH FL DENVER, CO 80202 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $2K | $2K | 0.48% |
| COBIZ INSURANCE3 Filed as: COBIZ INSURANCE INC. | 1600 N BROADWAY 9TH FL. DENVER, CO 80202 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 2.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INS CO. EIN 59-1031071 PLAN ADMINISTRATOR | Non-monetary compensation; Contract Administrator; Other services; Direct payment from the plan; Float revenue; Participant communication; Claims processing; Named fiduciary Service code 12 | 900 COTTAGE GROVE ROAD BLOOMFIELD, CA 06002 | $62K |
| CIGNA HEALTH AND LIFE INSURANCE | Other services; Contract Administrator; Direct payment from the plan; Claims processing; Named fiduciary; Float revenue; Participant communication; Non-monetary compensation Service code 12 | — | $0 |
| CIGNA HEALTH AND LIFE INSURANCE CO. | Named fiduciary; Float revenue; Direct payment from the plan; Participant communication; Non-monetary compensation; Other services; Contract Administrator; Claims processing Service code 12 | — | $0 |
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 | 139 | 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) | 139 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 139 | $465K |
| Dental | DELTA DENTAL OF COLORADO | 320 | $104K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 139 | $465K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 160 | $69K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 160 | $69K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 160 | $69K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 160 | $69K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 320 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.