| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MONTANA AUTOMOBILE DEALERS ASSOC4 | 501 N. SANDERS ST. HELENA, MT 59601 | UNUM LIFE INSURANCE CO OF AMERICA | $7K | — | $7K | 15.00% |
| MONTANA AUTOMOBILE DEALERS ASSOC4 | 501 N. SANDERS ST. HELENA, MT 59601 | UNUM LIFE INSURANCE CO OF AMERICA | $1K | — | $1K | 14.89% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFIT MANAGEMENT SERVICE EIN 81-0391256 UTILIZATION REV | Contract Administrator; Other fees Service code 13 | — | $183K |
| JACQ CREEK CONSULTING GROUP CONSULTING | Insurance services; Consulting (general) Service code 16 | 795 INSULATOR AVE. HELENA, MT 59602 | $104K |
| MTADA MANAGEMENT FEES | Direct payment from the plan Service code 50 | 501 N SANDERS HELENA, MT 59601 | $68K |
| IT STARTS WITH ME EIN 20-1378738 WELLNESS SCREENINGS | Direct payment from the plan Service code 50 | — | $47K |
| PRIME HEALTH SERVICES, INC. EIN 84-1375849 PPO | Other services Service code 49 | — | $31K |
| JCCS, PC EIN 81-0348775 AUDITOR | Accounting (including auditing) Service code 10 | — | $27K |
| MEDWATCH, LLC EIN 16-1662117 UTILIZATION MGMT | Other services Service code 49 | — | $22K |
| SMITH LAW FIRM EIN 81-0481142 LEGAL | Legal Service code 29 | — | $15K |
| DEPARTMENT OF THE TREASURY TAXING AUTHORITY | Other fees Service code 99 | INTERNAL REVENUE SERVICE CINCINNATI, OH 459990009 | $8K |
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 | 1,053 | 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) | 1,053 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNUM LIFE INSURANCE CO OF AMERICA | 685 | $45K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE INSURANCE CO | 1,054 | $375K |
| Other(2 contracts) | UNUM LIFE INSURANCE CO OF AMERICA | 685 | $53K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,054 | — |
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.