| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LEAVITT GROUP3 Filed as: LEAVITT GREAT WEST INS SERVICES LLC | 2345 KING AVE W BILLINGS, MT 59103 | LIFEMAP ASSURANCE COMPANY | $535 | — | $535 | 4.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ZENITH AMERICAN SOLUTIONS, INC. EIN 52-1590516 NONE | Plan Administrator; Accounting (including auditing); Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 10 | — | $349K |
| INTERWEST HEALTH EIN 84-1375849 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $95K |
| REINHART BOERNER VAN DEUREN NORRIS EIN 39-1126909 NONE | Legal; Direct payment from the plan Service code 29 | — | $73K |
| LEAVITT GREAT WEST INS SERVICES LLC EIN 93-6030398 NONE | Insurance services; Direct payment from the plan Service code 23 | — | $60K |
| AMERICAN HEALTH HOLDING INC EIN 31-1368946 NONE | Direct payment from the plan; Other services Service code 49 | — | $57K |
| ANASTASI, MOORE & MARTIN, PLLC EIN 20-8149084 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $40K |
| MED IMPACT HEALTH CARE EIN 33-0567651 NONE | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $28K |
| WELLS FARGO EIN 94-1347393 NONE | Custodial (other than securities); Direct payment from the plan; Custodial (securities) Service code 18 | — | $11K |
| REDMOND GENERAL INSURANCE AGENCY NONE | Insurance services; Direct payment from the plan Service code 23 | 16160 NE 80TH ST REDMOND, WA 98052 | $5K |
| LAWTON PRINTING SERVICES NONE | Other services; Direct payment from the plan Service code 49 | 4111 E MISSION AVE SPOKANE, WA 99202 | $5K |
| NICOLAI COCERGINE NONE | Trustee (individual); Direct payment from the plan Service code 20 | UFCW LOCAL NO. 4 P O BOX 567 BUTTE, MT 59703 | $0 |
| TERRIE TRETTENBACH NONE | Trustee (individual); Direct payment from the plan Service code 20 | UFCW LOCAL NO. 4 710 CUSTER AVE BILLINGS, MT 59101 | $0 |
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 | 1,029 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 26 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,055 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 697 | $56K |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 969 | $11K |
| Stop-loss / reinsurancereinsurance | MEDICAL EXCESS, LLC | 1,283 | $471K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,283 | — |
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.