| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SHIRAZI-MILLER BENEFITS LLC3 Filed as: SHIRAZI MILLER BENEFITS, LLC | 8205 WEST 20TH STREET GREELEY, CO 80635 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIANTS | $5K | $192 | $5K | 10.28% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS & FIN SVC LLC | 12404 PARK CENTRAL DRIVE SUITE 400S DALLAS, TX 75251 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIANTS | $0 | $2K | $2K | 3.96% |
| SHIRAZI-MILLER BENEFITS LLC3 Filed as: SHIRAZI MILLER BENEFITS, LLC | 8205 WEST 20TH STREET GREELEY, CO 80635 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $833 | $315 | $1K | 13.79% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK, SUITE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $270 | $270 | 3.24% |
| SHIRAZI-MILLER BENEFITS LLC3 Filed as: SHIRAZI MILLER BENEFITS, LLC | 8205 WEST 20TH STREET GREELEY, CO 80635 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICES, INC. | $741 | $0 | $741 | 11.92% |
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 | 114 | 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) | 114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIANTS | 67 | $49K |
| Vision | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICES, INC. | 144 | $6K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 121 | $8K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 121 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 144 | — |
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.