| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 2000 SOUTH COLORADO BOULEVARD SUITE 2-150 DENVER, CO 80222 | ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION, INC. | $41K | $0 | $41K | 1.85% |
| MICHAEL A. DAVIS3 | 111 EAST 3RD STREET, SUITE 220 RIFLE, CO 81650 | NORTHWESTERN MUTUAL | $5K | $1K | $6K | 6.10% |
| THEODORE FINANCIAL GROUP INC3 Filed as: THEODORE FINANCIAL GROUP INC. | 1873 SOUTH BELLAIRE STREET SUITE 1600 DENVER, CO 80222 | NORTHWESTERN MUTUAL | $1K | $121 | $1K | 1.09% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 844663 DALLAS, TX 75284 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.19% |
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 | 299 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 302 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION, INC. | 299 | $2.2M |
| Dental | DELTA DENTAL OF COLORADO | 321 | $114K |
| Vision | VISION SERVICE PLAN | 166 | $27K |
| Long-term disability | NORTHWESTERN MUTUAL | 254 | $103K |
| Prescription drug | ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION, INC. | 299 | $2.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 321 | — |
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.