| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BENEFIT COMMERCE GROUP | 16220 N SCOTTSDALE RD STE 100 SCOTTSDALE, AZ 85254 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | $3K | $0 | $3K | 0.69% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 300 GALLERIA PARKWAY STE 1100 ATLANTA, GA 30339 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | $2K | $0 | $2K | 0.40% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BENEFIT COMMERCE GROUP LLC | 2829 WYANDOT ST DENVER, CO 80211 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 6.18% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 300 GALLERIA PARKWAY STE 1100 ATLANTA, GA 30339 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $587 | $0 | $587 | 1.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BENEFIT COMMERCE GROUP LLC | 2829 WYANDOT ST DENVER, CO 80211 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 8.13% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 300 GALLERIA PARKWAY STE 1100 ATLANTA, GA 30339 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 6.87% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BENEFIT COMMERCE GROUP LLC | 2829 WYANDOT ST DENVER, CO 80211 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $964 | $0 | $964 | 8.32% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 300 GALLERIA PARKWAY STE 1100 ATLANTA, GA 30339 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $775 | $0 | $775 | 6.69% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BENEFIT COMMERCE GROUP LLC | 2829 WYANDOT ST DENVER, CO 80211 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $822 | $0 | $822 | 8.65% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 300 GALLERIA PARKWAY STE 1100 ATLANTA, GA 30339 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $604 | $0 | $604 | 6.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BENEFIT COMMERCE GROUP LLC | 2829 WYANDOT ST DENVER, CO 80211 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $324 | $0 | $324 | 8.12% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 300 GALLERIA PARKWAY STE 1100 ATLANTA, GA 30339 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $274 | $0 | $274 | 6.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ROCKY MOUNTAIN HOSPITAL & MEDICAL EIN 84-0747736 NOT APPLICABLE | Other services; Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | — | $164K |
| BENEFIT COMMERCE GROUP | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions Service code 22 | — | $23K |
| DIGITAL INSURANCE LLC | Insurance agents and brokers; Other commissions; Insurance brokerage commissions and fees Service code 22 | — | $12K |
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 | 101 | 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) | 101 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 0 | $438K |
| Dental | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 0 | $438K |
| Vision | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 0 | $438K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 101 | $21K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 110 | $63K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 31 | $23K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 101 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 110 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.