| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CYPRESS BENEFIT ADMINISTRATORS, LLC3 | 5560 W. GRANDE MARKET DRIVE APPLETON, WI 54913 | INTERMEDIARY INSURANCE SERVICE | $17K | — | $17K | 6.95% |
| CORPORATE BENEFIT DESIGN3 Filed as: CORPORATE BENEFIT DESIGN LLC | 5347 S VALENTIA WAY SUITE 300 ENGLEWOOD, CO 801113147 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | — | $5K | 6.33% |
| INS EXCHANGE LLC3 | 5 ROEHM CT WEST ORANGE, NJ 070523147 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $1K | $5K | 5.66% |
| 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 GREENWOOD VILLAGE, CO 80111 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INSURANCE | $2K | — | $2K | 9.59% |
| BETA HEALTH ASSOCIATION3 | 6200 SOUTH SYRACUSE WAY GREENWOOD VILLAGE, CO 80111 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INSURANCE | $93 | $2K | $2K | 7.67% |
| CORPORATE BENEFIT DESIGN3 | 5347 S VALENTIA WAY STE 130 GREENWOOD VILLAGE, CO 80111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
| BRADLEY ROTHHAMMER3 | 6455 S YOSEMITE # 300 ENGLEWOOD, CO 80110 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $985 | — | $985 | 9.86% |
| CYPRESS BENEFIT ADMINISTRATORS, LLC3 | 5560 W. GRANDE MARKET DRIVE APPLETON, WI 54913 | WESTPORT INSURANCE CORP | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CYPRESS BENEFIT ADMINISTRATORS, LLC EIN 39-1997579 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | 5560 W. GRANDE MARKET DRIVE APPLETON, WI 54913 | $70K |
| CORPORATE BENEFIT DESIGN EIN 84-1489722 INSURANCE AGENT | Custodial (securities) Service code 19 | 5347 S VALENTIN WAY SUITE 200 GREENWOOD VILLAGE, CO 80111 | $64K |
| HSTECHNOLOGY SOLUTIONS EIN 27-1818792 OTHER | Other fees Service code 99 | 3857 BIRCH STREET SUITE 586 NEWPORT BEACH, CA 92660 | $32K |
| MEDWATCH EIN 16-1662117 OTHER | Other fees Service code 99 | PO BOX 21796 TAMPA, FL 33630 | $10K |
| HEALTHEOS EIN 95-3959252 OTHER | Other fees Service code 99 | PO BOX 29380 NEW YORK, NY 100879380 | $10K |
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 | 421 | 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) | 421 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | INTERMEDIARY INSURANCE SERVICE | 244 | $247K |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 298 | $91K |
| Vision | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INSURANCE | 274 | $23K |
| Life insurance(3 contracts, 3 carriers) | INTERMEDIARY INSURANCE SERVICE | 442 | $265K |
| Prescription drug(2 contracts, 2 carriers) | INTERMEDIARY INSURANCE SERVICE | 244 | $247K |
| Other(3 contracts, 3 carriers) | INTERMEDIARY INSURANCE SERVICE | 244 | $273K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 442 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.