| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FLOOD & PETERSON BENEFITS LLC3 Filed as: FLOOD & PETERSON INSURANCE INC | PO BOX 578 GREELEY, CO 80632 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 13.56% |
| FLOOD & PETERSON BENEFITS LLC3 Filed as: FLOOD & PETERSON INS INC | 4687 W. 18TH ST GREENLEY, CO 80634 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 17.47% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HCC BENEFITS CORP EIN 52-0795746 CLAIMS PROCESSING | Claims processing Service code 12 | — | $120K |
| FLOOD & PETERSON EIN 84-0475762 INSURANCE AGENT | Custodial (securities) Service code 19 | — | $27K |
| CYPRESS BENEFIT ADMINISTRATORS, LLC EIN 39-1997579 CONTRACT ADMIN. | Claims processing Service code 12 | — | $26K |
| CONNECTICUT GENERAL LIFE INSURANCE EIN 06-0303370 OTHER | Other fees Service code 99 | — | $16K |
| AMERICAN HEALTH HOLDING EIN 31-1368946 OTHER | Other fees Service code 99 | — | $3K |
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 | 140 | 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) | 141 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC BENEFITS CORP | 117 | $244K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $17K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $17K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 121 | $19K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 121 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 130 | — |
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.