| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CYPRESS BENEFIT ADMINISTRATORS, LLC3 | 5560 W. GRANDE MARKET DRIVE APPLETON, WI 54913 | HM INSURANCE GROUP | $21K | — | $21K | 5.92% |
| BETA HEALTH ASSOCIATION3 | 6200 S SYRACUSE WAY STE 460 GREENWOOD VILLAGE, CO 80111 | DELTA DENTAL OF COLORADO | $3K | $3K | $6K | 8.28% |
| CORPORATE BENEFIT DESIGN3 Filed as: CORPORATE BENEFIT DESIGN LLC | 5347 S VALENTIA WAY SUITE 300 ENGLEWOOD, CO 80111 | DELTA DENTAL OF COLORADO | $6K | — | $6K | 7.24% |
| CYPRESS BENEFIT ADMINISTRATORS, LLC3 | 5560 W. GRANDE MARKET DRIVE APPLETON, WI 54913 | MEDICAL EXCESS INS REVIEW | — | — | $0 | 0.00% |
| CORPORATE BENEFIT DESIGN3 | 5347 S VALENTIA WAY STE 130 GREENWOOD VILLAGE, CO 80111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
| CORPORATE BENEFIT DESIGN3 | 5347 S. VALENTIA WAY GREENWOOD VILLAGE, CO 80111 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INSURANCE | $2K | — | $2K | 10.75% |
| BETA HEALTH ASSOCIATION3 | 6200 SOUTH SYRACUSE WAY GREENWOOD VILLAGE, CO 80111 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INSURANCE | $2K | — | $2K | 8.60% |
| BRADLEY ROTHHAMMER3 | 6455 S YOSEMITE # 300 ENGLEWOOD, CO 80111 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $712 | — | $712 | 6.17% |
| CADA INSURANCE SERVICES INC3 Filed as: CADA INSURANCE INC | 290 SPEER BLVD DENVER, CO 80203 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $320 | — | $320 | 2.77% |
| V.W. ALLABASHI & ASSOCIATES, LLC3 Filed as: V.W. ALLABASHI & ASSOC LLC | 6851 SOUTH HOLLY CRC ENGLEWOOD, CO 80112 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $21 | — | $21 | 0.18% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CORPORATE BENEFIT DESIGN EIN 84-1489722 INSURANCE AGENT | Custodial (securities) Service code 19 | 5347 S VALENTIN WAY SUITE 200 GREENWOOD VILLAGE, CO 80111 | $86K |
| CYPRESS BENEFIT ADMINISTRATORS, LLC EIN 39-1997579 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | 5560 W. GRANDE MARKET DRIVE APPLETON, WI 54913 | $85K |
| CONNECTICUT GENERAL LIFE INS EIN 45-2645014 OTHER | Other fees Service code 99 | PO BOX 645014 CINCINNATI, OH 452645014 | $51K |
| WARNER PACIFIC INS SERVICE EIN 95-3959252 INSURANCE AGENT | Custodial (securities) Service code 19 | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | $12K |
| ICR BRIDGE LLC EIN 26-1513899 OTHER | Other fees Service code 99 | 818 W RIVERSIDE SUITE 800 SPOKANE, WA 99201 | -$5 |
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 | 226 | 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) | 226 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HM INSURANCE GROUP | 226 | $356K |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF COLORADO | 117 | $89K |
| Vision | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INSURANCE | 162 | $21K |
| Life insurance(2 contracts, 2 carriers) | HM INSURANCE GROUP | 226 | $378K |
| Prescription drug | HM INSURANCE GROUP | 226 | $356K |
| Other(2 contracts, 2 carriers) | HM INSURANCE GROUP | 226 | $389K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 226 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.