| 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 | 3.35% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS NL LLC | 4500 TOWN CENTER DR STE 200 JEFFERSONVILLE, IN 47130 | HARTFORD LIFE AND ACCIDENT | — | $3K | $3K | 0.72% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF COLORADO, LLC | 4582 S ULSTER ST STE 600 DENVER, CO 80237 | VISION SERVICE PLAN | $3K | — | $3K | 2.37% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF CO LLC | 1873 S BELLAIRE ST #600 DENVER, CO 80022 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $393 | — | $393 | 1.22% |
| AMY E GRIFFIN3 | 1905 STERLING LN FORT COLLINS, CO 80521 | AFLAC | $669 | $28 | $697 | 3.74% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF CO LLC | 1873 S BELLAIRE ST #600 DENVER, CO 80022 | AFLAC | $393 | — | $393 | 2.11% |
| LAURA M MARCOTTE3 Filed as: LAURA PROBASCO | 4928 SILVERWOOD DR JOHNSTOWN, CO 80534 | AFLAC | $204 | $13 | $217 | 1.16% |
| LISA MARIE HODGES3 Filed as: LISA HODGES | 70 QUEEN RD CANDLER, NC 28715 | AFLAC | $204 | $13 | $217 | 1.16% |
| CHRISTINE A EDGERTON3 | 23135 NW POND RD BUXTON, OR 97109 | AFLAC | $121 | — | $121 | 0.65% |
| WENDY M SHELLY3 | 9947 CORBRIDGE ST LAS VEGAS, NV 89178 | AFLAC | $100 | — | $100 | 0.54% |
| KATRINA R DOCKTER3 | 2414 O ST APT 1 SACRAMENTO, CA 95816 | AFLAC | $85 | — | $85 | 0.46% |
| DANIEL L FRENCH3 | 240 43RD AVE GREELEY, CO 80634 | AFLAC | $67 | — | $67 | 0.36% |
| COLISTA R SHETLER3 | 2418 PEBBLE SPRINGS CT HENDERSON, NV 89074 | AFLAC | $49 | — | $49 | 0.26% |
| MATTHEW J MITTAN3 | PO BOX 71 SWANNANOA, NC 28778 | AFLAC | $45 | — | $45 | 0.24% |
| JOHN P THOMPSON3 | 6395 S KEWAUNEE WAY STE 425 AURORA, CO 80016 | AFLAC | $40 | — | $40 | 0.21% |
| ALAN LECLAIRE3 Filed as: ALAN R LECLAIRE | 28 GEORGETOWN FORT MYERS, FL 33919 | AFLAC | $37 | — | $37 | 0.20% |
| ROBERT C BERTRAM3 | 9265 COUNTY ROAD 57 KEENESBURG, CO 80643 | AFLAC | $37 | — | $37 | 0.20% |
| RIGGS COUNSELMAN MICHAELS & DOWNES3 Filed as: GARRY RIGGS | 950 SOUTHRIDGE GREENS BLVD UNIT 30 FORT COLLINS, CO 80525 | AFLAC | $37 | — | $37 | 0.20% |
| MATASHA MCCORMICK3 | 27 AMYS WAY BLACK MOUNTAIN, NC 28711 | AFLAC | $29 | $3 | $32 | 0.17% |
| JONATHAN SAMUEL KIRKLAND3 | 1270 HOPEWELL CRST ALPHARETTA, GA 30004 | AFLAC | $29 | — | $29 | 0.16% |
| LINDA ANN RASKIND3 | 9710 MALVERN DR TAMARAC, FL 33321 | AFLAC | $22 | — | $22 | 0.12% |
| JACOB M KIMSEY3 Filed as: JACOB KIMSEY | 1846 BREVARD RD ARDEN, NC 28704 | AFLAC | $18 | $3 | $21 | 0.11% |
| STEPHEN B THACKSTON3 | 20050 OAK RD E UNIT 301 GULF SHORES, AL 36542 | AFLAC | $19 | — | $19 | 0.10% |
| KYLE PROBASCO3 | 4928 SILVERWOOD DR JOHNSTOWN, CO 80534 | AFLAC | $19 | — | $19 | 0.10% |
| SERAPIO M. NAMBO3 Filed as: SERAPIO M NAMBO | 2175 57TH AVE SACRAMENTO, CA 95822 | AFLAC | $15 | — | $15 | 0.08% |
| THERESA NETTO PHILLIPS3 Filed as: THERESA A CHAMBLISS | 2059 PINE RIVER DR KINGWOOD, TX 77339 | AFLAC | $14 | — | $14 | 0.08% |
| SUSAN RUSSELL3 | 120 ROCKWOOD DR HENDERSONVILLE, NC 28792 | AFLAC | $12 | — | $12 | 0.06% |
| DAVID E SCHMIDT3 | 331 SAN MARCO WAY SAINT PETERS, MO 63304 | AFLAC | $11 | — | $11 | 0.06% |
| JAMES S SARANTIS3 | 14132 SE FIRCREST CT PORTLAND, OR 97236 | AFLAC | $11 | — | $11 | 0.06% |
| RYAN L STOOKEY3 | 1 METCALF DR BELLEVILLE, IL 62223 | AFLAC | $10 | — | $10 | 0.05% |
| JOSE DE LOS SANTOS III3 | 15550 E COPPER CREEK LN PARKER, CO 80134 | AFLAC | $9 | — | $9 | 0.05% |
| DIANA CABRAL RENTCHLER3 | PO BOX 54 WEST SACRAMENTO, CA 95691 | AFLAC | $8 | — | $8 | 0.04% |
| TINA WAY3 | 15550 E COPPER CREEK LN PARKER, CO 80134 | AFLAC | $6 | — | $6 | 0.03% |
| KENT HORSMAN3 | 1600 STIFEL WOODS DR CHESTERFIELD, MO 63017 | AFLAC | $5 | — | $5 | 0.03% |
| TANYA L MARTINSON3 | 6395 S KEWAUNEE WAY AURORA, CO 80016 | AFLAC | $5 | — | $5 | 0.03% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: DANIEL A JAIME | 1150 GUSTINE ST CHULA VISTA, CA 91913 | AFLAC | $4 | — | $4 | 0.02% |
| BARRY A WHITE3 | 4506 BANTAM WAY ELK GROVE, CA 95758 | AFLAC | $3 | — | $3 | 0.02% |
| ALLISON FARRIS WENDELBERGER3 | 207 SANTA FE DR WALNUT CREEK, CA 94598 | AFLAC | $3 | — | $3 | 0.02% |
| G SCOTT COOKE3 Filed as: SCOTT E NIELSEN | 718B W FOURTH PLAIN BLVD VANCOUVER, WA 98660 | 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% |
| PATTI ELMORE3 | 6927 KOKEAU OL KAPAA, HI 96746 | 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% |
| ERIC DANIEL WEILAND3 | 14511 SW CORNERSTONE LN SHERWOOD, OR 97140 | AFLAC | $2 | — | $2 | 0.01% |
| DIANN KRZCIOK3 | 17295 SHARON RD CHESANNING, MI 48616 | AFLAC | $1 | — | $1 | 0.01% |
| LINDA BAILEY3 Filed as: LINDA G BAILEY | 6505 DEADERICK CT ORANGEVALE, CA 95662 | 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% |
| BRIAN D NEUNER3 | 7651 E HIGHWAY WW COLUMBIA, MO 65201 | AFLAC | $0 | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AMERIBEN / IEC GROUP EIN 84-1225570 THIRD PART ADMIN | Contract Administrator; Claims processing Service code 12 | — | $263K |
| VSP EIN 06-1227840 VISION ADMIN FEES | Claims processing; Contract Administrator Service code 12 | — | $45K |
| COMPSYCH CORPORATION EIN 36-3739783 EAP ADMIN | Contract Administrator; Claims processing Service code 12 | — | $20K |
| PAYLOCITY ADMIN FEES | Contract Administrator; Claims processing Service code 12 | 2302 INTERNATIONAL LN MADISON, WI 53704 | $17K |
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 | 831 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 6 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 844 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 815 | $32K |
| Vision | VISION SERVICE PLAN | 490 | $124K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 831 | $447K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 831 | $447K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 831 | $447K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 831 | $466K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 831 | — |
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."
No prospect flags tripped on this filing.