| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMALYN CONSULTING LLC3 Filed as: AMALYN CONSULTING | 12590 N 73RD PL SCOTTSDALE, AZ 85260 | AETNA LIFE INSURANCE CO. | $126K | — | $126K | 4.12% |
| THE PARTNERS GROUP3 | 11850 SW 67TH AVE STE 100 PORTLAND, OR 97223 | DELTA DENTAL OF COLORADO | $5K | — | $5K | 4.64% |
| GBS BENEFITS INS AGENCY3 Filed as: GBS COLORADO | 2040 TERRY ST STE 101 LONGMONT, CO 80501 | DELTA DENTAL OF COLORADO | $3K | — | $3K | 2.54% |
| AMALYN CONSULTING LLC3 | 12590 N 73RD PLACE SCOTTSDALE, AZ 85260 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 5.65% |
| GBS BENEFITS INS AGENCY3 Filed as: GBS COLORADO LLC | 2040 TERRY ST #101 LONGMONT, CO 80501 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 3.95% |
| THE PARTNERS GROUP3 | 11850 SW 67TH AVE STE 100 PORTLAND, OR 97223 | STANDARD INSURANCE COMPANY | $711 | — | $711 | 0.95% |
| THE PARTNERS GROUP3 Filed as: THE PARTNERS GROUP LTD | 11850 SW 67TH AVE STE 100 PORTLAND, OR 97223 | EMBER ASSURANCE, INC | $2K | — | $2K | 6.48% |
| GBS BENEFITS INS AGENCY3 Filed as: GBS COLORADO LLC | 2040 TERRY ST STE 101 LONGMONT, CO 80501 | EMBER ASSURANCE, INC | $916 | — | $916 | 3.63% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIMS PROCESSING | Claims processing; Participant communication; Float revenue; Named fiduciary; Other services; Direct payment from the plan; Non-monetary compensation; Contract Administrator Service code 12 | — | $91K |
| AETNA LIFE INSURANCE CO. EIN 06-6033492 BROKER | Insurance agents and brokers Service code 22 | — | $24K |
| CIGNA | Direct payment from the plan; Contract Administrator; Claims processing; Non-monetary compensation; Other services; Named fiduciary; Float revenue; Participant communication Service code 12 | — | $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 | 401 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 401 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 568 | $3.2M |
| Dental(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 568 | $3.2M |
| Vision(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 568 | $3.1M |
| Life insurance | STANDARD INSURANCE COMPANY | 405 | $75K |
| Long-term disability | STANDARD INSURANCE COMPANY | 405 | $75K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 568 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.