| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 4047 CONCORD, CA 94524 | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE, INC. | $43K | $1 | $43K | 1.59% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS. AND FINANCIAL SVCS | 12404 PARK CENTRAL DRIVE SUITE 400S DALLAS, TX 75251 | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE, INC. | $0 | $12K | $12K | 0.46% |
| INTREPID3 Filed as: INTREPID BENEFITS INC | 1900 GRANT STREET, SUITE 650 DENVER, CO 80203 | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE, INC. | $0 | $0 | $0 | 0.00% |
| MOOD INSURANCE AGENCY INC3 | 8055 EAST TUFTS AVENUE, SUITE 1230 DENVER, CO 80237 | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE, INC. | $0 | $0 | $0 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 1125 17TH STREET, SUITE 900 DENVER, CO 80202 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $14K | $9K | $23K | 10.82% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NEW ENGLAND LLC | 1517 WILLOW LOOP PARK CITY, UT 84098 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $0 | $8K | 3.66% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 2000 SOUTH COLORADO BOULEVARD TOWER 2, SUITE 150 DENVER, CO 80222 | DELTA DENTAL OF COLORADO | $14K | $0 | $14K | 10.00% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS. SERVICES INC | 6143 SOUTH WILLOW DRIVE, SUITE 200 GREENWOOD VILLAGE, CO 80111 | DELTA DENTAL OF COLORADO | $6K | $0 | $6K | 4.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | VISION SERVICE PLAN | $1K | $0 | $1K | 3.76% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NEW ENGLAND LLC | 300 BALLARDVALE STREET WILMINGTON, MA 01887 | VISION SERVICE PLAN | $735 | $0 | $735 | 2.67% |
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 | 96 | 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) | 96 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE, INC. | 343 | $2.7M |
| Dental | DELTA DENTAL OF COLORADO | 337 | $140K |
| Vision | VISION SERVICE PLAN | 118 | $28K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 96 | $210K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 96 | $210K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 96 | $210K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 96 | $210K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 343 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.