Form 5500 · Employee benefit plan · COLORADO SPRINGS, CO
BOMBBOMB, INC.
The filing calls this plan BOMBBOMB, LLC HEALTH AND WELFARE BENEFIT PLAN.
Public Form 5500 records show how BOMBBOMB, INC. of COLORADO SPRINGS, CO, a professional services employer, structures its employee benefits. Its broker of record is HUB INTERNATIONAL INS SVCS INC.. Coverage is written through UNITED OF OMAHA LIFE INSURANCE COMPANY and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 35-2649699 · plan 501 · plan year 2023, filed Jul 19, 2024
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
Benefits declared on this filing
Also declared: death benefits.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 2 insured contracts covering health, life and disability; the largest, with UNITED OF OMAHA LIFE INSURANCE COMPANY, covers 67 people.
The filing declares health, life, disability, dental and vision. Dental and vision appear with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.
Reported premium across the insured contracts is $57,935, with $8,583 in disclosed broker commissions — about 15% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
HUB INTERNATIONAL INS SVCS INC. is the broker of record on 1 of the 2 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life, Disability | 67 | Jan 1, 2024 | $42,122 | $5,283 |
| NICE HEALTHCARE PLLC | Health | 97 | Jan 1, 2024 | $15,813 | $3,300 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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