| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | SERVICES INC 4371 LATHAM ST #101 RIVERSIDE, CA 92501 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | $16K | — | $16K | 1.42% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | SERVICES INC PO BOX 2158 RIVERSIDE, CA 92516 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | $14K | — | $14K | 1.28% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 1700 LINCOLN STREET 9TH FLOOR DENVER, CO 80203 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | $12K | — | $12K | 1.04% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 213 SOUTH JEFFERSON STREET SOUTHWE ROANOKE, VA 24011 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | $0 | $3K | $3K | 0.23% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | SERVICES INC 4371 LATHAM ST #101 RIVERSIDE, CA 92501 | ANTHEM LIFE INSURANCE COMPANY | $983 | — | $983 | 1.42% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | SERVICES INC PO BOX 2158 RIVERSIDE, CA 92516 | ANTHEM LIFE INSURANCE COMPANY | $886 | — | $886 | 1.28% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 1700 LINCOLN STREET 9TH FLOOR DENVER, CO 80203 | ANTHEM LIFE INSURANCE COMPANY | $719 | — | $719 | 1.04% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 213 SOUTH JEFFERSON STREET SOUTHWE ROANOKE, VA 24011 | ANTHEM LIFE INSURANCE COMPANY | $0 | $161 | $161 | 0.23% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | SERVICES, INC PO BOX 844663 DALLAS, TX 752844663 | VISION SERVICE PLAN | $513 | — | $513 | 3.86% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | NATIONAL, INC. PO BOX 202914 DALLAS, TX 753202914 | VISION SERVICE PLAN | $275 | — | $275 | 2.07% |
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 | 226 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 230 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 265 | $1.1M |
| Dental | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 110 | $74K |
| Vision | VISION SERVICE PLAN | 89 | $13K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 196 | $69K |
| Short-term disability | ANTHEM LIFE INSURANCE COMPANY | 196 | $69K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 196 | $69K |
| Other | ANTHEM LIFE INSURANCE COMPANY | 196 | $69K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 265 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.