Form 5500 · Employee benefit plan · GREELEY, CO
LONE TREE SERVICES, LLC
The filing calls this plan LONE TREE SERVICES LLC EMPLOYEE BENEFITS PLAN.
Public Form 5500 records show how LONE TREE SERVICES, LLC of GREELEY, CO, a retail employer, structures its employee benefits. Its broker of record is SHIRAZI MILLER BENEFITS, LLC. Coverage is written through AETNA LIFE INSURANCE COMPANY and 3 other carriers. The plan's most recent policy period ended in September.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 81-4774368 · plan 501 · plan year 2025, filed May 6, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: death benefits, other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 5 insured contracts covering health, dental, vision, life and disability; the largest, with AETNA LIFE INSURANCE COMPANY, covers 294 people.
Reported premium across the insured contracts is $1,945,780, with $137,405 in disclosed broker commissions — about 7.1% of premium.
The health contract's policy period ended in September, while at least one ancillary line's policy period ended in March. The plan is on a split renewal cycle.
SHIRAZI MILLER BENEFITS, LLC is the broker of record on 2 of the 5 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including AETNA LIFE INSURANCE COMPANY, AFLAC, STANDARD INSURANCE COMPANY and AMFIRST. AETNA LIFE INSURANCE COMPANY writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY | Health, Vision | 294 | Oct 1, 2025 | $1,526,266 | $76,479 |
| AFLAC | Dental, Vision, Disability | 95 | Oct 1, 2025 | $186,775 | $28,340 |
| AMFIRST | Health | 0 | Apr 1, 2025 | $68,707 | $18,209 |
| STANDARD INSURANCE COMPANY | Life, Disability | 221 | Apr 1, 2025 | $102,010 | $11,316 |
| STANDARD INSURANCE COMPANY | Life, Disability | 238 | Oct 1, 2025 | $62,022 | $3,061 |
Premium and claims on these contracts
STANDARD INSURANCE COMPANY, contract 165632. For the contract year on this filing, the carrier reported $102,010 in premium earned and $4,910 in claims incurred. Dividing one by the other gives 5%.
STANDARD INSURANCE COMPANY, contract 165632. For the contract year on this filing, the carrier reported $62,022 in premium earned and $24,835 in claims incurred. Dividing one by the other gives 40%.
- STANDARD INSURANCE COMPANY, contract 165632 reported $97,104 in retention.
- STANDARD INSURANCE COMPANY, contract 165632 reported $48,679 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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