| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| 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 | 2.11% |
| CASTLE LAKE INSURANCE LLC3 Filed as: CASTLE LAKE INSURANCE, LLC | PO BOX 2751 IDAHO FALLS, IA 83403 | DELTA DENTAL OF IDAHO | $639 | — | $639 | 0.90% |
| MATTHEW B WALDRAM3 Filed as: MATTHEW WALDRAM | 1601 ANTLER DR IDAHO FALLS, ID 834041226 | UNITED HERITAGE LIFE INSURANCE COMPANY | $1K | — | $1K | 3.47% |
| 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 | $813 | — | $813 | 9.42% |
| APONTE, CARLOS A3 | 136 S 1ST W REXBURG, ID 83440 | LIFEMAP ASSURANCE COMPANY | $45 | — | $45 | 0.52% |
| MATTHEW B WALDRAM3 | PO BOX 2751 IDAHO FALLS, ID 83403 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $338 | — | $338 | 11.94% |
| DENISE A MAXWELL3 | 3501 W TORANA DR MERIDIAN, ID 83646 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | $5 | $52 | 1.84% |
| MATTHEW B WALDRAM3 | PO BOX 2751 IDAHO FALLS, ID 83403 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $109 | — | $109 | 10.25% |
| DENISE A MAXWELL3 | 3501 W TORANA DR MERIDIAN, ID 83646 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | $1 | $15 | 1.41% |
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 | 166 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 166 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF IDAHO | 151 | $71K |
| Vision | UNITED HERITAGE LIFE INSURANCE COMPANY | 130 | $41K |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 210 | $9K |
| Other(3 contracts, 2 carriers) | LIFEMAP ASSURANCE COMPANY | 210 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 210 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.