| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: CRAGIN & PIKE | 10000 W. CHARLESTON BLVD. SUITE 200 LAS VEGAS, NV 89102 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. AND HMO COLORADO | $12K | — | $12K | 2.29% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: CRAGIN & PIKE | 10000 W. CHARLESTON BLVD. SUITE 200 LAS VEGAS, NV 89102 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $14K | — | $14K | 13.57% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: CRAGIN & PIKE | 2603 W CHARLESTON BLVD LAS VEGAS, NV 89102 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 2.40% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL EIN 84-0747736 CLAIMS ADMIN | Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator Service code 12 | — | $259K |
| HMO COLORADO, INC EIN 84-1017384 CLAIMS ADMIN | Float revenue; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $87K |
| CRAGIN & PIKE INC EIN 84-1017384 BROKER | Insurance agents and brokers; Other commissions; Insurance brokerage commissions and fees Service code 22 | 2603 W. CHARLESTON BLVD LAS VEGAS, NV 89102 | $0 |
| INGENIORX, INC EIN 82-3062245 RX ADMIN | Other services; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator Service code 12 | — | -$37K |
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 | 270 | 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) | 270 | 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 | 399 | $537K |
| Dental | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. AND HMO COLORADO | 399 | $537K |
| Vision | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. AND HMO COLORADO | 399 | $537K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 126 | $102K |
| Stop-loss / reinsurancereinsurance | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. AND HMO COLORADO | 399 | $537K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 126 | $102K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 399 | — |
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."
No prospect flags tripped on this filing.