| 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 AND MEDICAL SERVICE, INC. | $39K | $0 | $39K | 2.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 111 SOUTH TEJON STREET, SUITE 113 COLORADO SPRINGS, CO 80903 | HUMANADENTAL INSURANCE COMPANY | $4K | $216 | $4K | 2.48% |
| 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 | $15K | $8K | $23K | 15.20% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 111 SOUTH TEJON STREET, SUITE 113 COLORADO SPRINGS, CO 80903 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $0 | $6K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $1K | $0 | $1K | 3.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | PO BOX 195556 SAN JUAN, PR 00919 | HUMANA HEALTH PLANS OF PUERTO RICO, INC. | $2K | $0 | $2K | 6.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 111 SOUTH TEJON STREET, SUITE 113 COLORADO SPRINGS, CO 80903 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $4K | $0 | $4K | 12.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 2000 SOUTH COLORADO BOULEVARD TOWER 2, SUITE 150 DENVER, CO 80222 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $3K | $0 | $3K | 10.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 844663 DALLAS, TX 75284 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $933 | $0 | $933 | 3.11% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 1125 17TH STREET, SUITE 900 DENVER, CO 80202 | CONTINENTAL AMERICAN INSURANCE COMPANY | $5K | $0 | $5K | 30.21% |
| TONYA M DORMAN3 Filed as: TONYA M. DORMAN | 8569 VALLEY RANCH POINT FOUNTAIN, CO 80817 | CONTINENTAL AMERICAN INSURANCE COMPANY | $39 | $0 | $39 | 0.22% |
| CLINT ERIC WEIGHT3 | 706 SOUTH 320 EAST SALEM, UT 84653 | CONTINENTAL AMERICAN INSURANCE COMPANY | $8 | $0 | $8 | 0.04% |
| BRYAN R. DORMAN3 Filed as: BRYAN DORMAN | 8569 VALLEY RANCH POINT FOUNTAIN, CO 80817 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4 | $0 | $4 | 0.02% |
| THOMAS J PITZENBERGER3 Filed as: THOMAS JOSEPH PITZENBERGER | 1501 SUGARLAND PARKWAY PLEASANT HILL, MO 64080 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2 | $0 | $2 | 0.01% |
| JONATHAN SAMUEL KIRKLAND3 Filed as: JONATHAN S. KIRKLAND | 1270 HOPEWELL CREST ALPHARETTA, GA 30004 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1 | $0 | $1 | 0.01% |
| MJ INSURANCE3 Filed as: TINA WAY AND VARIOUS AGENTS | 155 INVERNESS DRIVE WEST SUITE 300 ENGLEWOOD, CO 80122 | CONTINENTAL AMERICAN INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | PO BOX 195556 SAN JUAN, PR 00919 | MULTINATIONAL LIFE INSURANCE COMPANY | $3K | $0 | $3K | 18.66% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL PUERTO RICO, INC. | PO BOX 195556 SAN JUAN, PR 00919 | MULTINATIONAL LIFE INSURANCE COMPANY | $231 | $0 | $231 | 1.33% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL SOUTHWEST | UNKNOWN PHOENIX, AZ 85008 | NEW BENEFITS, LTD | $533 | $0 | $533 | 23.71% |
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 | 286 | 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) | 286 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 208 | $1.4M |
| Dental(2 contracts, 2 carriers) | HUMANADENTAL INSURANCE COMPANY | 196 | $201K |
| Vision(2 contracts, 2 carriers) | HUMANA HEALTH PLANS OF PUERTO RICO, INC. | 430 | $62K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 286 | $170K |
| Short-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 286 | $170K |
| Long-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 286 | $170K |
| Prescription drug(3 contracts, 3 carriers) | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 208 | $1.4M |
| Other(6 contracts, 6 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 286 | $236K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 430 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.