| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SHIRAZI-MILLER BENEFITS LLC3 Filed as: SHIRAZI BENEFITS LLC | 8205 WEST 20TH ST GREELEY, CO 80634 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $89K | $6K | $96K | 8.89% |
| SHIRAZI-MILLER BENEFITS LLC3 Filed as: SHIRAZI MILLER BENEFITS LLC | 8205 WEST 20TH ST GREELEY, CO 80634 | CIGNA GROUP INSURANCE -DENTAL | $22K | — | $22K | 9.89% |
| SHIRAZI-MILLER BENEFITS LLC3 | 8205 WEST 20TH ST GREELEY, CO 80634 | UNITED OF OMAHA - LONG TERM DISABILITY INSURED | $5K | $2K | $7K | 13.15% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA - LONG TERM DISABILITY INSURED | — | $1K | $1K | 2.70% |
| SHIRAZI-MILLER BENEFITS LLC3 | 8205 WEST 20TH ST GREELEY, CO 80634 | VISION SERVICE PLAN | $1K | — | $1K | 4.10% |
| SHIRAZI-MILLER BENEFITS LLC3 | 8205 WEST 20TH ST GREELY, CO 80634 | UNITED OF OMAHA - LIFE & AD&D | $3K | $1K | $4K | 13.29% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA - LIFE & AD&D | — | $937 | $937 | 2.82% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CONTRACT ADMINISTRATOR | Direct payment from the plan; Float revenue; Other services; Contract Administrator; Participant communication; Named fiduciary; Non-monetary compensation; Claims processing Service code 12 | — | $59K |
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 | 371 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 373 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 327 | $1.1M |
| Dental | CIGNA GROUP INSURANCE -DENTAL | 323 | $227K |
| Vision | VISION SERVICE PLAN | 296 | $36K |
| Life insurance | UNITED OF OMAHA - LIFE & AD&D | 348 | $33K |
| Long-term disability | UNITED OF OMAHA - LONG TERM DISABILITY INSURED | 347 | $55K |
| Other | UNITED OF OMAHA - LIFE & AD&D | 348 | $33K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 348 | — |
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.