| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LEAVITT GROUP3 Filed as: LEAVITT GREAT WEST INSURANCE | PO BOX 2518 BILLINGS, MT 59103 | PACIFIC SOURCE HEALTH PLANS | $51K | — | $51K | 3.11% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: PAYNEWEST INSURANCE INC. | 424 MAIN STREET POLSON, MT 59860 | PACIFIC SOURCE HEALTH PLANS | $7K | — | $7K | 0.41% |
| LEAVITT GROUP3 Filed as: LEAVITT GREAT WEST INSURANCE | PO BOX 2518 BILLINGS, MT 591032518 | VSP | $759 | — | $759 | 7.40% |
| PEAK 1 ADMINISTRATION LLC3 Filed as: PEAK 1 ADMINISTRATION, LLC | 7600 MINERAL DRIVE SUITE 450 COEUR DALENE, ID 83815 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $693 | — | $693 | 20.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BANCSERVE, INC. EIN 81-0434481 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $21K |
| MONTANA NONPROFIT ASSOCIATION EIN 73-1654969 PLAN SPONSOR | Other fees Service code 99 | — | $21K |
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 | 488 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 491 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFIC SOURCE HEALTH PLANS | 618 | $1.6M |
| Dental | PACIFIC SOURCE HEALTH PLANS | 618 | $1.6M |
| Vision(2 contracts, 2 carriers) | PACIFIC SOURCE HEALTH PLANS | 618 | $1.7M |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 273 | $3K |
| Prescription drug | PACIFIC SOURCE HEALTH PLANS | 618 | $1.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 618 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.