| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COPIC INSURANCE AGENCY3 | 7351 LOWRY BLVD STE 400 DENVER, CO 80230 | PRINCIPAL LIFE INSURANCE COMPANY | $10K | — | $10K | 7.53% |
| COPIC INSURANCE AGENCY3 Filed as: COPIC AGENCY | 7351 LOWRY BLVD, STE 400 DENVER, CO 80230 | VISION SERVICE PLAN | $1K | — | $1K | 4.16% |
| DON C SUNDAY3 | 2037 S GRAY DR LAKEWOOD, CO 80227 | AFLAC | $972 | — | $972 | 5.39% |
| COPIC INSURANCE AGENCY3 Filed as: COPIC AGENCY | 7351 E LOWRY BLVD STE 400 DENVER, CO 80230 | AFLAC | $357 | — | $357 | 1.98% |
| REGINA K SANTANGELO3 | 6892 S WEBSTER WAY LITTLETON, CO 80128 | AFLAC | $288 | — | $288 | 1.60% |
| JENNIFER L FOSS3 | 3177 W INDIAN SUMMER LN CASTLE ROCK, CO 80109 | AFLAC | $112 | — | $112 | 0.62% |
| TIMOTHY B ASBY3 | 11500 GOLDEN WILLOW CT ZIONSVILLE, IN 46077 | AFLAC | $77 | — | $77 | 0.43% |
| JONATHAN SAMUEL KIRKLAND3 | 1270 HOPEWELL CRST ALPHARETTA, GA 30004 | AFLAC | $69 | — | $69 | 0.38% |
| JOHN M LOUDEN3 | 22739 E PRENTICE PL AURORA, CO 80015 | AFLAC | $50 | — | $50 | 0.28% |
| JACK GATHINGS3 | 7235 S GOLFSIDE LN PHOENIX, AZ 85042 | AFLAC | $50 | — | $50 | 0.28% |
| JILL E MOORE3 | 2985 S OGDEN ST ENGLEWOOD, CO 80113 | AFLAC | $42 | — | $42 | 0.23% |
| DAVID HANCOCK INC3 | PO BOX 423 LAVON, TX 75166 | AFLAC | $42 | — | $42 | 0.23% |
| JOHN P THOMPSON3 | 6395 S KEWAUNEE WAY STE 425 AURORA, CO 80016 | AFLAC | $24 | — | $24 | 0.13% |
| DAVID V PAYNE3 | 225 EAGLE CT MONROE, MI 48162 | AFLAC | $21 | — | $21 | 0.12% |
| ZENAT SHARIFF BELKIN3 | 14204 W EVANS CIR LAKEWOOD, CO 80228 | AFLAC | $19 | — | $19 | 0.11% |
| JOSE DE LOS SANTOS III3 | 15550 E COPPER CREEK LN PARKER, CO 80134 | AFLAC | $18 | — | $18 | 0.10% |
| DAVID J KASKA3 | 1862 DENVER WEST CT APT 224 LAKEWOD, CO 80401 | AFLAC | $16 | — | $16 | 0.09% |
| TINA WAY3 | 15550 E COPPER CREEK LN PARKER, CO 80134 | AFLAC | $10 | — | $10 | 0.06% |
| ALLISON FARRIS WENDELBERGER3 | 207 SANTA FE DR WALNUT CREEK, CA 94598 | AFLAC | $3 | — | $3 | 0.02% |
| TANYA L MARTINSON3 | 6395 S KEWAUNEE WAY AURORA, CO 80016 | AFLAC | $2 | — | $2 | 0.01% |
| KIEFER GROUP INSURANCE AGENCY LLC3 | 155 INVERNESS DR W STE 300 ENGLEWOOD, CO 80112 | AFLAC | $1 | — | $1 | 0.01% |
| JOHN W AMOS3 Filed as: JOHN P THOMPSON JR | 236 HAVERSHAM RD DELTONA, FL 32725 | AFLAC | $1 | — | $1 | 0.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC EIN 33-0441200 PHARMACY BENEFIT MGMT | Float revenue; Other fees; Direct payment from the plan; Claims processing Service code 12 | — | $238K |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $104K |
| COPIC INSURANCE COMPANY EIN 84-0953991 BROKER | Other commissions Service code 55 | 7351 EAST LOWRY BLVD SUITE 400 DENVER, CO 80230 | $55K |
| DELTA DENTAL OF COLORADO EIN 84-0568337 DENTAL CLAIMS ADMIN | Contract Administrator Service code 13 | PO BOX 173803 DENVER, CO 802173803 | $10K |
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 | 110 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 39 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 149 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 105 | $26K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 334 | $128K |
| Short-term disability | AFLAC | 16 | $18K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 334 | $128K |
| Stop-loss / reinsurancereinsurance | SUMMIT REINSURANCE SVCS INC - COMPANION | 102 | $493K |
| Other(2 contracts, 2 carriers) | COPIC INSURANCE COMPANY | 122 | $88K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 334 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.