| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF FLORIDA3 Filed as: REGENCE BLUESHIELD OF IDAHO, INC | — | REGENCE BLUESHIELD OF IDAHO, INC | — | — | $0 | 0.00% |
| DELTA DENTAL3 | PO BOX 2870 BOISE, ID 83701 | DELTA DENTAL | $2K | — | $2K | 1.00% |
| MYRIAD BENEFITS INC3 Filed as: MYRIAD BENEFITS LLC | PO BOX 370 MERIDIAN, ID 83680 | METROPOLITAN LIFE INSURANCE COMPANY | $11K | — | $11K | 9.89% |
| MYRIAD BENEFITS INC3 Filed as: MYRIAD BENEFITS, LLC | 280 E. CORPORATE DRIVE STE 200 MERIDIAN, ID 83642 | VISION SERVICE PLAN | $1K | — | $1K | 5.83% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| REGENCE BLUESHIELD OF IDAHO, INC EIN 82-0206874 CLAIMS PROCESSING | Contract Administrator Service code 13 | — | $165K |
| BPA HEALTH CONSULTATION | Contract Administrator Service code 13 | 380 E PARKCENTER BLVD STE 300 BOISE, ID 83706 | $9K |
| MBA ADMINISTRATORS LLC EIN 26-2322611 ADMINISTRATOR | Contract Administrator Service code 13 | 830 N MAIN STREET STE 200 MERIDIAN, ID 83642 | $5K |
| HOLLAND & HART, LLP EIN 84-0382505 ATTORNEY | Legal Service code 29 | 800 W MAIN STREET, SUITE 1750 BOISE, ID 83702 | $713 |
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 | 369 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 369 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUESHIELD OF IDAHO, INC | 569 | $371K |
| Dental | DELTA DENTAL | 314 | $223K |
| Vision | VISION SERVICE PLAN | 312 | $17K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 537 | $112K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 537 | $112K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 537 | $112K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 569 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.