Form 5500 · Employee benefit plan · GLENWOOD SPRINGS, CO
HOLY CROSS ELECTRIC ASSOCIATION
The filing calls this plan HOLY CROSS ELECTRIC ASSOCIATION MEDICAL AND DENTAL BENEFITS PLAN.
HOLY CROSS ELECTRIC ASSOCIATION of GLENWOOD SPRINGS, CO files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is HUB INTERNATIONAL INS SERVICES, INC. Coverage is written through UNITED OF OMAHA LIFE INSURANCE COMPANY and 4 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 84-0229176 · plan 501 · plan year 2025, filed Jul 28, 2026
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How this plan is funded
Self-funded as reported
The filing reports benefits paid from the plan's own money, and no medical insurance contract on Schedule A.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
Benefits declared on this filing
3 contracts on this filing do not say which benefits they cover, so a line above may be insured by one of them.
Also declared: death benefits, other welfare.
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 5 insured contracts covering vision, life and disability; the largest, with UNITED OF OMAHA LIFE INSURANCE COMPANY, covers 176 people.
The filing declares vision, life, disability, health and dental. Health and dental appear with no insured contract on Schedule A. That coverage may be self-funded, placed with a carrier that is not on this filing, or written on one of the 3 contracts here that do not say what they cover.
Reported premium across the insured contracts is $338,176, with $47,263 in disclosed broker commissions — about 14% 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 SERVICES, INC is the broker of record on 3 of the 5 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 | 176 | Jan 1, 2026 | $266,148 | $39,922 |
| CONTINENTAL AMERICAN INSURANCE COMPANY | — | 28 | Jan 1, 2026 | $31,683 | $4,824 |
| MUTUAL OF OMAHA INSURANCE COMPANY | — | 62 | Jan 1, 2026 | $8,428 | $1,264 |
| VISION SERVICE PLAN | Vision | 134 | Jan 1, 2026 | $25,102 | $1,253 |
| TRIAD RESOURCE GROUP, LLC, DBA TRIAD EAP | — | 175 | Jan 1, 2026 | $6,815 | $0 |
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. The service providers are named on Schedule C of this filing. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 176 employees, 3 recordable cases, 3 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Money the plan held and paid out
Sourced from U.S. DOL EFAST2 Form 5500 · Schedule H
These are the plan's own figures from Schedule H, the financial statement it files. They are not the premium on Schedule A.
How this plan compares
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