| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CORPORATE BENEFIT DESIGN3 Filed as: CORPORATE BENEFIF DESIGN LLC | 5347 S VALENTIA WAY SUITE 130 GREENWOOD VILLAGE, CO 801113147 | UNITED CONCORDIA INSURANCE COMPANY | $6K | — | $6K | 9.02% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA RD F3 WESTLAKE VILLAGE, CA 91361 | UNITED CONCORDIA INSURANCE COMPANY | $3K | — | $3K | 4.51% |
| CORPORATE BENEFIT DESIGN3 | 5347 S VALENTIA WAY STE 130 GREENWOOD VILLAGE, CO 80111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.26% |
| CORPORATE BENEFIT DESIGN3 | 5347 S. VALENTIA WAY GREENWOOD VILLAGE, CO 80111 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INSURANCE | $1K | — | $1K | 9.38% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 6200 SOUTH SYRACUSE WAY GREENVILLAGE, CO 80111 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INSURANCE | $748 | — | $748 | 5.00% |
| BRADLEY ROTHHAMMER3 | 2405 CHERRYRIDGE RD ENGLEWOOD, CO 80110 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $657 | — | $657 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ALLIED BENEFIT SYSTEMS, LLC EIN 36-3086057 TPA | Plan Administrator; Contract Administrator Service code 13 | — | $71K |
| CORPORATE BENEFIT DESIGN EIN 84-1489722 AGENT FEES | Insurance agents and brokers Service code 22 | 5347 S VALENTIA WAY, STE 300 GREENWOOD VILLAGE, CO 80111 | $46K |
| FIRST HEALTH EIN 20-1736437 TPA | Plan Administrator; Contract Administrator Service code 13 | — | $9K |
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 | 308 | 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) | 308 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 215 | $12K |
| Dental(3 contracts, 3 carriers) | UNITED CONCORDIA INSURANCE COMPANY | 215 | $82K |
| Vision(2 contracts, 2 carriers) | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INSURANCE | 215 | $27K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 359 | $16K |
| Stop-loss / reinsurancereinsurance | PAN-AMERICAN LIFE INSURANCE COMPANY | 142 | $174K |
| Other | UNITED HEALTHCARE INSURANCE COMPANY | 215 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 359 | — |
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.