| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ZP INSURANCE LLC3 | 525 20TH STREET SAN FRANCISCO, CA 941074345 | UNITEDHEALTHCARE INSURANCE COMPANY | $20K | $0 | $20K | 1.19% |
| THE SEGAL COMPANY3 Filed as: THE SEGAL COMPANY (EASTERN STATES) | 333 W 34TH ST NEW YORK, NY 100012402 | UNITEDHEALTHCARE INSURANCE COMPANY | $17K | $0 | $17K | 1.01% |
| ZP INSURANCE LLC3 | 525 20TH ST SAN FRANCISCO, CA 94107 | UNITEDHEALTHCARE INSURANCE COMPANY | $3K | $0 | $3K | 0.17% |
| DKG INSURANCE & FINANCIAL SERVICES3 | 12404 PARK CENTRAL DR, STE 400S DALLAS, TX 752511814 | UNITEDHEALTHCARE INSURANCE COMPANY | -$4 | $0 | -$4 | -0.00% |
| BOK FINANCIAL INSURANCE3 Filed as: BOK FINANCIAL INSURANCE INC. | 1600 BROADWAY DENVER, CO 802024927 | UNITEDHEALTHCARE INSURANCE COMPANY | -$4 | $0 | -$4 | -0.00% |
| WITH GUSTO INSURANCE SERVICE LLC3 | 525 20TH STREET SAN FRANCISCO, CA 94107 | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICES, INC. (G1525) | $7K | $0 | $7K | 6.37% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE & FINANCIAL | 12404 PARK CENTRAL DR, SUITE 400S DALLAS, TX 75251 | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICES, INC. (G1525) | $0 | $3K | $3K | 2.55% |
| THE SEGAL COMPANY3 Filed as: THE SEGAL COMPANY (EASTERN STATES) | 333 W. 34TH STREET NEW YORK, NY 10001 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | $0 | $1K | 12.46% |
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 | 109 | 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) | 109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 297 | $1.7M |
| Dental | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICES, INC. (G1525) | 312 | $104K |
| Vision | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICES, INC. (G1525) | 312 | $104K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 167 | $11K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 167 | $11K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 167 | $11K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 167 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 312 | — |
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.