| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LEAVITT GROUP3 Filed as: LEAVITT GREAT WEST INS SVCS | — | DELTA DENTAL INSURANCE COMPANY | $8K | — | $8K | 10.49% |
| LEAVITT GROUP3 Filed as: LEAVITT GREAT WEST INS SERVICES LLC | 2345 KING AVENUE WEST SUITE E BILLINGS, MT 59102 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $5K | 21.02% |
| LEAVITT GROUP3 Filed as: LEAVITT GREAT WEST INSURANCE SERVIC | PO BOX 2518 BILLINGS, MT 59103 | VISION SERVICE PLAN | $1K | — | $1K | 5.37% |
| LEAVITT GROUP3 Filed as: LEAVITT GREAT WEST INS SERVICES LLC | 2345 KING AVENUE WEST SUITE E BILLINGS, MT 59102 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $3K | 16.17% |
| LEAVITT GROUP3 Filed as: LEAVITT GREAT WEST INS SERVICES LLC | 2345 KING AVENUE WEST SUITE E BILLINGS, MT 59102 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 20.47% |
| LEAVITT GROUP3 Filed as: LEAVITT GREAT WEST INS SERVICES LLC | 2345 KING AVENUE WEST SUITE E BILLINGS, MT 59102 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $466 | $1K | 21.79% |
| LEAVITT GROUP3 Filed as: LEAVITT GREAT WEST INS SERVICES LLC | 2345 KING AVENUE WEST SUITE E BILLINGS, MT 59102 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $878 | $335 | $1K | 20.73% |
| LEAVITT GROUP3 Filed as: LEAVITT GREAT WEST INS SERVICES LLC | 2345 KING AVENUE WEST SUITE E BILLINGS, MT 59102 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $173 | $173 | 7.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFIT MGMT SYSTEMS LLC EIN 81-0391256 TPA | Contract Administrator Service code 13 | — | $58K |
| SMITH HEALTH INC EIN 81-1489804 RX ADMIN FEES | Claims processing Service code 12 | — | $15K |
| IT STARTS WITH ME EIN 20-1378738 HEALTH SCREENING | Other fees Service code 99 | — | $12K |
| FIRST CHOICE HEALTH EIN 91-1272766 PPO | Other services Service code 49 | — | $9K |
| AMERICAN HEALTH HOLDING, INC. EIN 31-1368946 PHYSICIAN CONSULTING | Other fees Service code 99 | — | $5K |
| PUBLIC GOOD EIN 15-0329043 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $2K |
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 | 141 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 143 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL INSURANCE COMPANY | 112 | $81K |
| Vision | VISION SERVICE PLAN | 96 | $21K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 182 | $19K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 20 | $7K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 182 | $18K |
| Stop-loss / reinsurancereinsurance | BERKLEY LIFE AND HEALTH INSURANCE COMPANY | 141 | $345K |
| Other(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 182 | $50K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 182 | — |
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."
No prospect flags tripped on this filing.