| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLACK INK BENEFITS3 Filed as: BLACK INK INSURANCE INC | APONTE, CARLOS A 136 S 1ST W REXBURG, ID 83440 | REGENCE BLUESHIELD OF IDAHO, INC. | $55K | $5K | $60K | 5.33% |
| BLACK INK BENEFITS3 Filed as: BLACK INK INSURANCE INC DBA | INTERMOUNTAIN INSURANCE SERVICE 136 S 1ST W REXBURG, ID 83440 | DELTA DENTAL OF IDAHO | $1K | — | $1K | 2.03% |
| CASTLE LAKE INSURANCE LLC3 Filed as: CASTLE LAKE INSURANCE, LLC | PO BOX 2751 IDAHO FALLS, IA 83403 | DELTA DENTAL OF IDAHO | $567 | — | $567 | 0.87% |
| MATTHEW B WALDRAM3 Filed as: MATTHEW WALDRAM | 1601 ANTLER DR IDAHO FALLS, ID 834041226 | UNITED HERITAGE LIFE INSURANCE COMPANY | $1K | — | $1K | 9.55% |
| ROD FURNISS EMPLOYEE BENEFITS3 Filed as: ROD FURNISS EMPLOYEE BENEFITS INC | DBA BLACK INK S 136 S 1ST W REXBURG, ID 83440 | LIFEMAP ASSURANCE COMPANY | $778 | — | $778 | 8.11% |
| MATTHEW B WALDRAM3 | PO BOX 2751 IDAHO FALLS, ID 83403 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $303 | — | $303 | 13.00% |
| DENISE A MAXWELL3 | 3501 W TORANA DR MERIDIAN, ID 83646 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $44 | $29 | $73 | 3.13% |
| JAREN ERICK NELSON3 | 136 SOUTH 1ST WEST REXBURG, ID 83440 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.90% |
| MATTHEW B WALDRAM3 | PO BOX 2751 IDAHO FALLS, ID 83403 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $256 | — | $256 | 17.07% |
| DENISE A MAXWELL3 | 3501 W TORANA DR MERIDIAN, ID 83646 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $28 | $19 | $47 | 3.13% |
| JAREN ERICK NELSON3 | 136 SOUTH 1ST WEST REXBURG, ID 83440 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.93% |
No Schedule C service providers reported on this filing.
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 | 161 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 162 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUESHIELD OF IDAHO, INC. | 181 | $1.1M |
| Dental | DELTA DENTAL OF IDAHO | 132 | $65K |
| Vision | UNITED HERITAGE LIFE INSURANCE COMPANY | 117 | $13K |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 37 | $10K |
| Other(3 contracts, 2 carriers) | LIFEMAP ASSURANCE COMPANY | 37 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 181 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.