Form 5500 · Employee benefit plan · BOULDER, CO
THE CIGARETTE STORE LLC
Public Form 5500 records show how THE CIGARETTE STORE LLC of BOULDER, CO, a retail employer, structures its employee benefits. Its broker of record is GBS COLORADO LLC. Coverage is written through HEALTH SELECT and 3 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 84-1182893 · plan 501 · as of Aug 2026
Plan brief
Schedule A lists 4 insured contracts covering health, dental, vision, life and disability; the largest, with HEALTH SELECT, covers 240 people.
Reported premium across the insured contracts is $780,344, with $66,402 in disclosed broker commissions — about 8.5% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
GBS COLORADO LLC is the broker of record on 3 of the 4 contracts; the rest name a different broker or none.
4 carriers appear on the filing — HEALTH SELECT, STANDARD INSURANCE COMPANY, SUN LIFE ASSURANCE COMPANY OF CANADA and GUARDIAN — with HEALTH SELECT writing the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| HEALTH SELECT | Health | 240 | December | $379,919 | $38,117 |
| SUN LIFE ASSURANCE COMPANY OF CANADA | Life, Disability | 156 | December | $123,124 | $14,220 |
| GUARDIAN | — | 191 | December | $73,308 | $10,996 |
| STANDARD INSURANCE COMPANY | Dental, Vision | 1,039 | December | $203,993 | $3,069 |
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