| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| QBA BENEFITS LLC3 Filed as: QBA BENEFITS, LLC. | 3395 LAWTON LANE CLEVELAND, OH 44124 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICES, INC. | $220K | $0 | $220K | 0.71% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | PO BOX 632886 CINCINNATI, OH 45263 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICES, INC. | $19K | $0 | $19K | 0.06% |
| QBA BENEFITS LLC3 Filed as: QBA BENEFITS, LLC. | 24610 DETROIT ROAD WESTLAKE, OH 44145 | DELTA DENTAL OF COLORADO | $173K | $0 | $173K | 8.25% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | 700 WEST 47TH STREET, SUITE 1100 KANSAS CITY, MO 64112 | DELTA DENTAL OF COLORADO | $36K | $0 | $36K | 1.69% |
| QBA BENEFITS LLC3 Filed as: QBA BENEFITS, LLC. | 24610 DETROIT ROAD WESTLAKE, OH 44145 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $181K | $38K | $219K | 16.29% |
| PLANSOURCE BENEFITS ADMN INC3 Filed as: PLANSOURCE BENEFITS ADMN., INC. | 701 XENIA AVENUE SOUTH, SUITE 150 MINNEAPOLIS, MN 55416 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $67K | $67K | 5.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | PO BOX 632886 CINCINNATI, OH 45263 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $20K | $0 | $20K | 1.52% |
No Schedule C service providers reported on this filing.
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 | 2,405 | 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) | 2,405 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICES, INC. | 6,622 | $31.0M |
| Dental | DELTA DENTAL OF COLORADO | 6,621 | $2.1M |
| Vision | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICES, INC. | 6,622 | $31.0M |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,540 | $1.3M |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,540 | $1.3M |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,540 | $1.3M |
| Prescription drug | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICES, INC. | 6,622 | $31.0M |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,540 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,622 | — |
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.