| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LEAVITT GROUP3 Filed as: LEAVITT GREAT WEST INS SERVICES LLC | 3390 COLTON DR STE A HELENA, MT 59602 | LIFEMAP ASSURANCE COMPANY | $1K | — | $1K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ZENITH AMERICAN SOLUTIONS, INC. EIN 52-1590516 NONE | Accounting (including auditing); Claims processing; Direct payment from the plan; Plan Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 10 | — | $306K |
| INTERWEST HEALTH EIN 84-1375849 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $229K |
| AMERICAN HEALTH HOLDING INC EIN 31-1368946 NONE | Other services; Direct payment from the plan Service code 49 | — | $107K |
| REINHART BOERNER VAN DEUREN NORRIS EIN 39-1126909 NONE | Legal; Direct payment from the plan Service code 29 | — | $68K |
| LEAVITT GREAT WEST INS SERVICES LLC EIN 93-6030398 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $62K |
| MED IMPACT HEALTH CARE EIN 33-0567651 NONE | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $35K |
| ANASTASI, MOORE & MARTIN, PLLC EIN 20-8149084 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $24K |
| WELLS FARGO EIN 94-1347393 NONE | Direct payment from the plan; Custodial (other than securities); Custodial (securities) Service code 18 | — | $13K |
| LAWTON PRINTING SERVICES NONE | Direct payment from the plan; Other services Service code 49 | 4111 E MISSION AVE SPOKANE, WA 99202 | $9K |
| LEGEND DATA SYSTEMS NONE | Other services; Direct payment from the plan Service code 49 | 18024 72ND AVE S KENT, WA 98302 | $8K |
| MEDICAL REHABILITATION CONSULTANTS EIN 91-1448997 NONE | Direct payment from the plan; Other services Service code 49 | — | $7K |
| REDMOND GENERAL INSURANCE AGENCY NONE | Direct payment from the plan; Insurance services Service code 23 | 16160 NE 80TH ST REDMOND, WA 98052 | $6K |
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 | 998 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 24 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,022 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 730 | $56K |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 926 | $12K |
| Short-term disability | LIFEMAP ASSURANCE COMPANY | 926 | $12K |
| Stop-loss / reinsurancereinsurance | MEDICAL EXCESS, LLC | 1,309 | $434K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,309 | — |
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.