| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COPIC INSURANCE AGENCY3 | 7351 LOWRY BLVD STE 400 DENVER, CO 802306083 | PRINCIPAL LIFE INSURANCE COMPANY | $13K | — | $13K | 6.61% |
| COPIC INSURANCE AGENCY3 Filed as: COPIC INSURANCE AGENCY INC. | 7351 LOWRY BLVD STE 400 DENVER, CO 80230 | DELTA DENTAL OF COLORADO | $15K | — | $15K | 10.00% |
| DON C SUNDAY Filed as: DON SUNDAY | 2037 S GRAY DR LAKEWOOD, CO 80227 | AFLAC | $447 | — | $447 | 5.26% |
| COPIC INSURANCE AGENCY Filed as: COPIC AGENCY | 7351 LOWRY BLVD STE 400 DENVER, CO 80230 | AFLAC | $176 | — | $176 | 2.07% |
| REGINA K SANTANGELO | 6892 S WEBSTER WAY LITTLETON, CO 80128 | AFLAC | $118 | — | $118 | 1.39% |
| JENNIFER L FOSS | 3177 W INDIAN SUMMER LN CASTLE ROCK, CO 80109 | AFLAC | $58 | — | $58 | 0.68% |
| JACK GATHINGS | 7235 S GOLFSIDE LN PHOENIX, AZ 85042 | AFLAC | $40 | — | $40 | 0.47% |
| TIMOTHY B ASBY | 11500 GOLDEN WILLOW CT ZIONSVILLE, IN 46077 | AFLAC | $33 | — | $33 | 0.39% |
| JON M LOUDEN | 22739 E PRENTICE PL AURORA, CO 80015 | AFLAC | $25 | — | $25 | 0.29% |
| DAVID HANCOCK INC Filed as: DAVID G HANCOCK | PO BOX 423 LAVON, TX 75166 | AFLAC | $22 | — | $22 | 0.26% |
| JOHNATHAN SAMUEL KIRKLAND | 1270 HOPEWELL CRST ALPHARETTA, GA 30004 | AFLAC | $19 | — | $19 | 0.22% |
| DAVID V PAYNE | 225 EAGLE CT. MONROE, MI 48162 | AFLAC | $17 | — | $17 | 0.20% |
| JILL E MOORE | 2985 S OGDEN ST ENGLEWOOD, CO 80113 | AFLAC | $17 | — | $17 | 0.20% |
| ZENAT SHARIFF BELKIN | 14204 W EVANS CIR LAKEWOOD, CO 80228 | AFLAC | $17 | — | $17 | 0.20% |
| DAVID J KASKA | 501 BOURLAND RD APT 3209 KELLER, TX 76248 | AFLAC | $15 | — | $15 | 0.18% |
| JOHN P THOMPSON | 6395 S KEWAUNEE WAY STE 425 AURORA, CO 80016 | AFLAC | $13 | — | $13 | 0.15% |
| JOSE DE LOS SANTOS III | 15550 E COPPER CREEK LN PARKER, CO 80134 | AFLAC | $6 | — | $6 | 0.07% |
| TINA WAY | 15550 E COPPER CREEK LN PARKER, CO 80134 | AFLAC | $5 | — | $5 | 0.06% |
| ALLISON FARRIS WENDELBERGER | 207 SANTA FE DR. WALNUT CREEK, CA 94598 | AFLAC | $2 | — | $2 | 0.02% |
| JOHN W AMOS Filed as: JOHN P THOMPSON JR | 1543 TEDDINGTON ST DELAND, FL 32720 | AFLAC | $1 | — | $1 | 0.01% |
| KIEFER GROUP INSURANCE AGCY LLC | 155 INVERNESS DR W STE 300 ENGLEWOOD, CO 80112 | AFLAC | $1 | — | $1 | 0.01% |
| TANYA L MARTINSON | 6395 S KEWAUNEE WAY AURORA, CO 80016 | AFLAC | $1 | — | $1 | 0.01% |
| CHAUNCEY DAVIS4 | 4606 FREEPORT WAY DENVER, CO 80239 | PRE-PAID LEGAL SERVICES INC DBA LEGAL SHIELD | $161 | — | $161 | 7.92% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUM RX INC. EIN 33-0441200 PHARMACY BENEFIT MANAGEME | Direct payment from the plan; Other fees; Claims processing; Float revenue Service code 12 | — | $987K |
| UMR INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $140K |
| COPIC INSURANCE COMPANY EIN 84-0953991 BROKER | Other commissions Service code 55 | 7351 LOWRY BLVD STE 400 DENVER, CO 80230 | $67K |
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 | 137 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 54 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 191 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF COLORADO | 301 | $155K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 387 | $202K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 387 | $202K |
| Short-term disability | AFLAC | 10 | $9K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 387 | $202K |
| Stop-loss / reinsurancereinsurance | SWISS RE-SWISS RE | 122 | $1.1M |
| Other(3 contracts, 3 carriers) | COPIC INSURANCE COMPANY | 102 | $47K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 387 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.