| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 Filed as: PAYNE WEST INSURANCE INC | PO BOX 4386 MISSOULA, MT 59808 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $56K | $7K | $63K | 7.09% |
| ASSUREX3 | 175 S THIRD ST STE 800 COLUMBUS, OH 43215 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $0 | $0 | 0.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: PAYNE WEST INSURANCE INC | PO BOX 4386 MISSOULA, MT 59808 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $496 | $3K | 12.75% |
| ASSUREX3 | 175 S THIRD ST STE 800 COLUMBUS, OH 43215 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $0 | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ALLEGIANCE BENEFIT PLAN MGMT INC EIN 81-6058650 NONE | Contract Administrator; Claims processing Service code 12 | — | $490K |
| WESTERN HEALTH SCREENING EIN 83-0293596 NONE | Consulting (general) Service code 16 | — | $199K |
| ALLONE HEALTH MANAGEMENT SOLUTIONS EIN 20-5457337 NONE | Consulting (general) Service code 16 | — | $106K |
| PAYNE WEST INSURANCE INC. EIN 81-0479558 NONE | Insurance agents and brokers Service code 22 | — | $85K |
| MERCER EIN 13-2834414 NONE | Consulting (general); Contract Administrator Service code 13 | — | $56K |
| FIRST CHOICE HEALTH NETWORK EIN 91-1272766 NONE | Contract Administrator Service code 13 | — | $38K |
| TELEDOC INC EIN 04-3705970 NONE | Consulting (general) Service code 16 | — | $33K |
| WISER TOGETHER EIN 26-2188993 NONE | Consulting (general) Service code 16 | — | $20K |
| MONTANA ASSOCIATION OF HEALTH CARE EIN 81-0511353 NONE | Other fees Service code 99 | — | $20K |
| CVS HEALTH CORPORATION EIN 05-0494040 NONE | Consulting (general); Claims processing Service code 12 | — | $14K |
| FIRST INTERSTATE WEALTH MANAGEMENT EIN 81-6023169 PLAN SPONSOR ENTITY | Trustee (bank, trust company, or similar financial institution); Investment management fees paid indirectly by plan Service code 21 | — | $13K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Accounting (including auditing) Service code 10 | — | $12K |
| CONRAD SIEGEL ACTUARIES EIN 23-1669823 NONE | Actuarial Service code 11 | — | $7K |
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 | 1,451 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 101 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,552 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 1,005 | $169K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,719 | $893K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,719 | $893K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE INSURANCE COMPANY | 1,405 | $703K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,719 | $917K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,719 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.