| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MOUNTAIN WEST BENEFIT SOLUTIONS3 | 3390 COLTON DR STE A HELENA, MT 59602 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $332 | $7K | 14.50% |
| MONTANA AUTOMOBILE DEALERS ASSOC0 | 501 N. SANDERS STREET HELENA, MT 59601 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 9.43% |
| LEAVITT GROUP3 Filed as: LEAVITT GREAT WEST INSURANCE SERVIC | 2345 KING AVE WEST SUITE A BILLINGS, MT 59103 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $936 | — | $936 | 4.65% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFIT MANAGEMENT SERVICE EIN 81-0391256 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $253K |
| MOUNTAIN WEST BENEFIT SOLUTIONS EIN 26-0576978 CONSULTING | Insurance services; Consulting (general) Service code 16 | — | $61K |
| EMPLOYEE BENEFIT MGMT SERVICES EIN 81-1391256 UTILIZATION REV | Other fees Service code 99 | — | $45K |
| INTERWEST HEALTH EIN 84-1375849 PPO | Other services Service code 49 | — | $39K |
| MEDIMPACT EIN 33-0567651 RX ADMIN FEES | Claims processing Service code 12 | — | $30K |
| JCCS, PC EIN 81-0348775 AUDITOR | Accounting (including auditing) Service code 10 | — | $9K |
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 | 1,116 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,116 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 964 | $48K |
| Prescription drug | COMPANION LIFE INSURANCE COMPANY | 1,607 | $698K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE INSURANCE COMPANY | 1,607 | $698K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 964 | $68K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,607 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.