| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: CRAGIN & PIKE | 2603 W CHARLESTON BLVD LAS VEGAS, NV 89102 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. AND HMO COLORADO | $14K | — | $14K | 2.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: CRAGIN & PIKE | 2603 W CHARLESTON BLVD LAS VEGAS, NV 89102 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $15K | — | $15K | 13.36% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL EIN 84-0747736 CLAIMS ADMIN | Other services; Float revenue; Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $324K |
| HMO COLORADO, INC EIN 84-1017384 CLAIMS ADMIN | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing; Other services Service code 12 | — | $155K |
| ROCKY MOUNTAIN HOSP & MED SERV | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing; Float revenue Service code 12 | — | $97K |
| CRAGIN & PIKE | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions Service code 22 | — | $44K |
| HMO COLORADO INC | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Float revenue; Other services Service code 12 | — | $26K |
| SHEA INSURANCE, LLC | Insurance agents and brokers; Other commissions; Insurance brokerage commissions and fees Service code 22 | — | -$6K |
| INGENIORX, INC EIN 82-3062245 RX ADMIN | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Float revenue; Claims processing; Other services Service code 12 | — | -$60K |
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 | 248 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 248 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. AND HMO COLORADO | 443 | $543K |
| Dental | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. AND HMO COLORADO | 443 | $543K |
| Vision | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. AND HMO COLORADO | 443 | $543K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 127 | $110K |
| Stop-loss / reinsurancereinsurance | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. AND HMO COLORADO | 443 | $543K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 127 | $110K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 443 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.