| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LEAVITT GROUP3 Filed as: STARLEY LEAVITT INSURANCE AGENCY IN | 715 SHOSHONE ST N TWIN FALLS, ID 83303 | REGENCE BLUESHIELD OF IDAHO, INC | $23K | $5K | $28K | 2.40% |
| GBS BENEFITS INC3 | 2200 S MAIN ST STE 600 SOUTH SALT LAKE, UT 84115 | REGENCE BLUESHIELD OF IDAHO, INC | $12K | — | $12K | 1.05% |
| GBS BENEFITS INC3 | 2200 S MAIN ST STE 600 SOUTH SALT LAKE, UT 84115 | NATIONWIDE LIFE INSURANCE COMPANY | $5K | — | $5K | 7.47% |
| LEAVITT GROUP3 Filed as: STARLEY LEAVITT INSURANCE AGENCY | TWIN FALLS ID PO BOX 1947 TWIN FALLS, ID 83301 | NATIONWIDE LIFE INSURANCE COMPANY | $2K | — | $2K | 2.52% |
| GBS BENEFITS INC3 | 2200 S MAIN ST STE 600 SOUTH SALT LAKE, UT 84115 | NATIONWIDE LIFE INSURANCE COMPANY | $3K | — | $3K | 7.55% |
| LEAVITT GROUP3 Filed as: STARLEY-LEAVITT INSURANCE AGENCY | TWIN FALLS ID PO BOX 1947 TWIN FALLS, ID 83301 | NATIONWIDE LIFE INSURANCE COMPANY | $885 | — | $885 | 2.45% |
| LEAVITT GROUP3 Filed as: STARLEY LEAVITT INSURANCE | 715 SHOSHONE ST N PO BOX 1947 TWIN FALLS, ID 83303 | LIFEMAP ASSURANCE COMPANY | $1K | — | $1K | 8.77% |
| GBS BENEFITS INC3 | 2200 S MAIN ST STE 600 SOUTH SALT LAKE, UT 84115 | NATIONWIDE LIFE INSURANCE COMPANY | $1K | — | $1K | 8.16% |
| LEAVITT GROUP3 Filed as: STARLEY-LEAVITT INSURNACE AGENCY | TWIN FALLS ID PO BOX 1947 TWIN FALLS, ID 83301 | NATIONWIDE LIFE INSURANCE COMPANY | $228 | — | $228 | 1.84% |
| JOSE CRUZ BLANCO3 | 328 W CUSTER AVE STE 2 APTK K HELENA, MT 59602 | AFLAC | $65 | $71 | $136 | 6.42% |
| LEAVITT GROUP3 Filed as: STARLEY LEAVITT INSURANCE AGENCYINC | 715 SHOSHONE ST N TWIN FALLS, ID 83301 | AFLAC | $67 | — | $67 | 3.16% |
| RICHARD R KIMBROUGH3 | 9505 CHAD COLLEY BLVD UNIT 3804 FORT SMITH, AR 72916 | AFLAC | $16 | $17 | $33 | 1.56% |
| GBS BENEFITS INC3 | 715 SHOSHONE ST N TWIN FALLS, ID 83301 | AFLAC | $24 | — | $24 | 1.13% |
| TYGER RICHMAN3 | 1363 BLUE JAY WAY TWIN FALLS, ID 83301 | AFLAC | $6 | $17 | $23 | 1.09% |
| SIMON E TAUTALA3 | 2955 N WATERBROOK AVE STAR, ID 83669 | AFLAC | $12 | — | $12 | 0.57% |
| SHANE F LAMAY3 | 2325 TANGERINE DR SARASOTA, FL 34239 | AFLAC | $10 | — | $10 | 0.47% |
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 | 192 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 192 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUESHIELD OF IDAHO, INC | 322 | $1.2M |
| Dental(3 contracts) | NATIONWIDE LIFE INSURANCE COMPANY | 103 | $122K |
| Vision(3 contracts) | NATIONWIDE LIFE INSURANCE COMPANY | 103 | $122K |
| Other | LIFEMAP ASSURANCE COMPANY | 215 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 322 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.