| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GBS BENEFITS INS AGENCY3 Filed as: GBS COLORADO LLC | 2040 TERRY ST STE 101 LONGMONT, CO 80501 | AMERITAS LIFE INSURANCE CORP | $3K | — | $3K | 10.00% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES N | 32110 AGOURA RD. WESTLAKE VILLAGE, CA 91361 | AMERITAS LIFE INSURANCE CORP | $2K | — | $2K | 5.00% |
| GBS BENEFITS INS AGENCY3 Filed as: GBS COLORADO LLC | 2040 TERRY ST STE 101 LONGMONT, CO 80501 | AMERICAN UNITED LIFE INSURANCE COMPANY | $2K | — | $2K | 12.71% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ROCKY MOUNTAIN HOSPITAL & MEDICAL EIN 84-0747736 CLAIMS PROCESSING | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Float revenue; Claims processing Service code 12 | — | $44K |
| CENTERSTONE INSURANCE AND FINANCIAL EIN 84-0747736 BROKER | Non-monetary compensation; Other commissions; Insurance agents and brokers Service code 22 | — | $0 |
| GBS COLORADO LLC EIN 84-0747736 BROKER | Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $0 |
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 | 152 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 152 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS LIFE INSURANCE CORP | 123 | $32K |
| Vision | AMERITAS LIFE INSURANCE CORP | 123 | $32K |
| Life insurance | AMERICAN UNITED LIFE INSURANCE COMPANY | 87 | $18K |
| Short-term disability | AMERICAN UNITED LIFE INSURANCE COMPANY | 87 | $18K |
| Stop-loss / reinsurancereinsurance | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE INC. | 87 | $231K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 123 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.