| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF COLORADO, LLC | 4582 S ULSTER ST STE 600 DENVER, CO 80237 | HARTFORD LIFE AND ACCIDENT | $15K | — | $15K | 3.82% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS NL LLC | 5905 E GALBRAITH RD STE 5000 CINCINNATI, OH 45236 | HARTFORD LIFE AND ACCIDENT | — | $2K | $2K | 0.55% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF COLORADO, LLC | 4582 S ULSTER ST STE 600 DENVER, CO 80237 | VISION SERVICE PLAN | $3K | — | $3K | 2.22% |
| JOHN W BELL3 | PO BOX 270550 FORT COLLINS, CO 80527 | AFLAC | $449 | $38 | $487 | 2.67% |
| AMY E GRIFFIN3 | PO BOX 270550 FORT COLLINS, CO 80527 | AFLAC | $391 | $44 | $435 | 2.38% |
| MATTHEW J MITTAN3 | PO BOX 71 SWANNANOA, NC 28778 | AFLAC | $285 | $45 | $330 | 1.81% |
| AMY E GRIFFIN3 | 5110 GRANITE ST STE A LOVELAND, CO 80538 | AFLAC | $193 | — | $193 | 1.06% |
| LAURA M MARCOTTE3 | 4928 SILVERWOOD DR JOHNSTOWN, CO 80534 | AFLAC | $175 | $13 | $188 | 1.03% |
| CHRISTINE A EDGERTON3 | 23350 NW POND RD BUXTON, OR 97109 | AFLAC | $113 | — | $113 | 0.62% |
| DANIEL L FRENCH3 | 240 43RD AVE GREELEY, CO 80634 | AFLAC | $80 | — | $80 | 0.44% |
| KATRINA R DOCKTER3 | 2414 O ST APT 1 SACRAMENTO, CA 95816 | AFLAC | $79 | — | $79 | 0.43% |
| WENDY M SHELLY3 | 3355 S TOWN CENTER DR APT 2001 LAS VEGAS, NV 89135 | AFLAC | $57 | — | $57 | 0.31% |
| COLISTA R SHETLER3 | 2418 PEBBLE SPRINGS CT HENDERSON, NV 89074 | AFLAC | $45 | — | $45 | 0.25% |
| SUSAN HAMER3 | 120 W ALLEN ST STE 20 HENDERSONVILLE, NC 28792 | AFLAC | $35 | $5 | $40 | 0.22% |
| KYLE PROBASCO3 | 4928 SILVERWOOD DR JOHNSTOWN, CO 80534 | AFLAC | $27 | $13 | $40 | 0.22% |
| JOHN P THOMPSON3 | 6935 S KEWAUNEE WAY STE 425 AURORA, CO 80016 | AFLAC | $38 | — | $38 | 0.21% |
| JONATHAN SAMUEL KIRKLAND3 | 1270 HOPEWELL CREST ALPHARETTA, GA 30004 | AFLAC | $37 | — | $37 | 0.20% |
| WENDY M SHELLY3 | 9947 CORBRIDGE ST LAS VEGAS, NV 89178 | AFLAC | $35 | — | $35 | 0.19% |
| ROBERT C BERTRAM3 | 9630 REMINGTON AVE FIRESTONE, CO 80504 | AFLAC | $34 | — | $34 | 0.19% |
| SHARMAIN L BOUNDS3 | 2202 TEDESCA DR HENDERSON, NV 89052 | AFLAC | $34 | — | $34 | 0.19% |
| MARY R HAUGHT3 Filed as: MARY KIMBERLY KUXHAUSEN | 2016 VAN BUREN AVE LOVELAND, CO 80538 | AFLAC | $32 | — | $32 | 0.18% |
| ALAN LECLAIRE3 Filed as: ALAN R LECLAIRE | 9182 ESTERO RIVER CIR ESTERO, FL 33928 | AFLAC | $24 | — | $24 | 0.13% |
| LINDA ANN RASKIND3 | 9710 MALVERN DR TAMARAC, FL 33321 | AFLAC | $20 | — | $20 | 0.11% |
| STEPHEN B THACKSTON3 | 5873 LAKE RESORT TERRACE APT E100 CHATTANOOGA, TN 37415 | AFLAC | $19 | — | $19 | 0.10% |
| SERAPIO M. NAMBO3 Filed as: SERAPIO M NAMBO | 2175 57TH AVE SACRAMENTO, CA 95822 | AFLAC | $19 | — | $19 | 0.10% |
| THERESA NETTO PHILLIPS3 Filed as: THERESA A CHAMBLISS | 2059 PINE RIVER DR KINGWOOD, TX 77339 | AFLAC | $17 | — | $17 | 0.09% |
| SUSAN RUSSELL3 | 120 W ALLEN ST STE 20 HENDERSONVILLE, NC 28792 | AFLAC | $10 | $4 | $14 | 0.08% |
| JOSE DE LOS SANTOS III3 | 15550 E COPPER CREEK LN PARKER, CO 80134 | AFLAC | $11 | — | $11 | 0.06% |
| DAVID E SCHMIDT3 | 331 SAN MARCO WAY SAINT PETERS, MO 63304 | AFLAC | $10 | — | $10 | 0.05% |
| ALAN LECLAIRE3 Filed as: ALAN LACLAIRE | 9182 ESTERO RIVER DRIVE ESTERO, FL 33928 | AFLAC | $10 | — | $10 | 0.05% |
| JAMES S SARANTIS3 | 2281 LAVA RIDGE CT STE 130 ROSEVILLE, CA 95661 | AFLAC | $10 | — | $10 | 0.05% |
| TINA WAY3 | 15550 E COPPER CREEK LN PARKER, CO 80134 | AFLAC | $8 | — | $8 | 0.04% |
| DIANA CABRAL RENTCHLER3 | PO BOX 54 WEST SACRAMENTO, CA 95691 | AFLAC | $7 | — | $7 | 0.04% |
| RYAN L STOOKEY3 | 1 METCALF DR BELLEVILLE, IL 62223 | AFLAC | $5 | — | $5 | 0.03% |
| KENT HORSMAN3 | 14162 LADUE RD CHESTERFIELD, MO 63017 | AFLAC | $5 | — | $5 | 0.03% |
| TANYA L MARTINSON3 | 6395 S KEWAUNEE WAY AURORA, CO 80016 | AFLAC | $5 | — | $5 | 0.03% |
| COLISTA R SHETLER3 | 9003 BELCONTE LN HENDERSON, NV 89074 | AFLAC | $4 | — | $4 | 0.02% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: DANIEL A JAIME | 1150 GUSTINE ST CHULA VISTA, CA 91913 | AFLAC | $3 | — | $3 | 0.02% |
| ALLISON FARRIS WENDELBERGER3 | 207 SANTA FE DR WALNUT CREEK, CA 94598 | AFLAC | $3 | — | $3 | 0.02% |
| RYAN L STOOKEY3 Filed as: RYAN STOOKEY | 1 METCALF DRIVE BELLEVILLE, IL 62223 | AFLAC | $3 | — | $3 | 0.02% |
| BARRY A WHITE3 | 4506 BANTAM WAY ELK GROVE, CA 95758 | AFLAC | $3 | — | $3 | 0.02% |
| JOHN W AMOS3 Filed as: JOHN P THOMPSON JR | 236 HAVERSHAM RD DELTONA, FL 32725 | AFLAC | $2 | — | $2 | 0.01% |
| LAWRENCE A ELMORE3 | PO BOX 244 MORRISON, CO 80465 | AFLAC | $2 | — | $2 | 0.01% |
| MICHAEL C WALKER3 Filed as: MICHAEL M STASTNY | 605 PORTLAND AVE UNIT 531 GLADSTONE, OR 97027 | AFLAC | $2 | — | $2 | 0.01% |
| G SCOTT COOKE3 Filed as: SCOTT E NIELSEN | 2709 DAY ISLAND BLVD W UNIT A UNIVERSITY PL, WA 98466 | AFLAC | $2 | — | $2 | 0.01% |
| ERIC DANIEL WEILAND3 | 14511 SW CORNERSTONE LN SHERWOOD, OR 97140 | AFLAC | $2 | — | $2 | 0.01% |
| RYAN L STOOKEY3 | 908 SOUTHGATE DR BELLEVILLE, IL 62223 | AFLAC | $1 | — | $1 | 0.01% |
| WILLIAM B KRZCIOK3 | 2760 FORT MYER AVE HENDERSON, NV 89052 | AFLAC | $1 | — | $1 | 0.01% |
| LINDA BAILEY3 Filed as: LINDA G BAILEY | 6505 DEADERICK CT ORANGEVALE, CA 95662 | AFLAC | $1 | — | $1 | 0.01% |
| G SCOTT COOKE3 Filed as: SCOTT E NIELSEN | 718B W FOURTH PLAIN BLVD VANCOUVER, WA 98660 | AFLAC | $1 | — | $1 | 0.01% |
| BRADLEY K HARRISON3 | 3432 W TRUMAN BLVD JEFFERSON CITY, MO 65109 | AFLAC | $1 | — | $1 | 0.01% |
| ROBIN M CALLAWAY3 | 10201 W MARKHAM ST STE 203 LITTLE ROCK, AR 72205 | AFLAC | $1 | — | $1 | 0.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AMERIBEN / IEC GROUP EIN 84-1225570 THIRD PART ADMIN | Claims processing Service code 12 | — | $216K |
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL EIN 84-0747736 THIRD PARTY ADMIN | Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Claims processing Service code 12 | — | $204K |
| COMPSYCH CORPORATION EIN 36-3739783 EAP ADMIN | Claims processing; Contract Administrator Service code 12 | — | $17K |
| TOTAL ADMINISTRATIVE SERVICES CORP EIN 39-1561025 PLAN ADMIN FEES | Contract Administrator; Claims processing Service code 12 | — | $14K |
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 | 668 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 673 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 665 | $30K |
| Vision | VISION SERVICE PLAN | 424 | $113K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 668 | $384K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 668 | $384K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 668 | $384K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 668 | $402K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 668 | — |
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.