| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: CRAGIN & PIKE INC | 2603 W CHARLESTON BLVD LAS VEGAS, NV 89102 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | $66K | — | $66K | 2.10% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE | 2340 CORPORATE CIRCLE HENDERSON, NV 89074 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | $43K | — | $43K | 1.36% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92612 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | $14K | $1K | $15K | 0.49% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE OF NEVADA | 975 KELLY JOHNSON DRIVE STE 100 LAS VEGAS, NV 89119 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 4.64% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: CRAGIN & PIKE INC | 2603 W CHARLESTON BLVD LAS VEGAS, NV 89102 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 3.01% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 1.61% |
| TABELLO INS SERVICES INC3 | 1561 E ORANGETHORPE AVE STE 200 FULLERTON, CA 92831 | AFLAC | $3K | — | $3K | 15.21% |
| TOAN HUU PHAM3 | 546 S HARBOR BLVD SANTA ANA, CA 92704 | AFLAC | $2K | — | $2K | 9.42% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. L | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | AFLAC | $2K | — | $2K | 8.34% |
| JONATHAN ALI HAJIMOMEN3 | 1561 E ORANGETHORPE AVE STE 200 FULLERTON, CA 92831 | AFLAC | $1K | — | $1K | 5.23% |
| BARBARA LYNN BRINSON3 | 2841 S SANDPIPER AVE ONTARIO, CA 91761 | AFLAC | $846 | — | $846 | 4.34% |
| SHAHID ZIA KHAWAJA3 | 436 BLUE JAY DR BREA, CA 92823 | AFLAC | $203 | — | $203 | 1.04% |
| RAMZI NORMAN TABELLO3 | 1464 SAN CLEMENTE CIR CORONA, CA 92882 | AFLAC | $179 | — | $179 | 0.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $41 | — | $41 | 0.21% |
| BRENDA F ROY3 | 341 STILLWATER LOOP KALISPELL, MT 59901 | AFLAC | $9 | — | $9 | 0.05% |
| COLISTA R SHETLER3 | 9003 BELCONTE LN HENDERSON, NV 89074 | AFLAC | $8 | — | $8 | 0.04% |
| DAWN A CHRISTENSEN3 | 24516 APPLE ST NEWHALL, CA 91321 | AFLAC | $6 | — | $6 | 0.03% |
| LYNN MARIE BARRY3 Filed as: LYNN G BARNSON | 10153 S WASATCH BLVD SANDY, UT 84902 | AFLAC | $5 | — | $5 | 0.03% |
| MICHAEL F IVES3 | 6127 S RAINBOW BLVD STE 110B LAS VEGAS, NV 89118 | AFLAC | $2 | — | $2 | 0.01% |
| COLISTA R SHETLER3 | 2418 PEBBLE SPRINGS CT HENDERSON, NV 89074 | AFLAC | $1 | — | $1 | 0.01% |
| TAMMY A MORGART3 Filed as: TAMMY A SWAIN | 10736 KNICKERBOCKER AVE LAS VEGAS, NV 89166 | AFLAC | $1 | — | $1 | 0.01% |
| WILLIAM B KRZCIOK3 | 2760 FORT MYER AVE HENDERSON, NV 89052 | AFLAC | $1 | — | $1 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: CRAGIN & PIKE INC. | 2603 W CHARLESTON BLVD LAS VEGAS, NV 89102 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $760 | — | $760 | 16.99% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $178 | — | $178 | 3.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: CRAGIN & PIKE INC. | 2603 W CHARLESTON BLVD LAS VEGAS, NV 89102 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $507 | — | $507 | 18.08% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INSURANCE | 1920 MAIN ST STE 600 IRVINE, CA 92614 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $54 | — | $54 | 1.93% |
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 | 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. | 418 | $3.1M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 205 | $178K |
| Vision(2 contracts, 2 carriers) | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 418 | $3.3M |
| Life insurance | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 418 | $3.1M |
| Short-term disability | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 418 | $3.1M |
| Long-term disability | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 418 | $3.1M |
| Prescription drug | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 418 | $3.1M |
| Other(4 contracts, 3 carriers) | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 418 | $3.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 418 | — |
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."
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.