| 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 | 2.08% |
| CASTLE LAKE INSURANCE LLC3 Filed as: CASTLE LAKE INSURANCE, LLC | PO BOX 2751 IDAHO FALLS, IA 83403 | DELTA DENTAL OF IDAHO | $545 | — | $545 | 0.89% |
| MATTHEW B WALDRAM3 Filed as: MATTHEW WALDRAM | 1601 ANTLER DR IDAHO FALLS, ID 834041226 | UNITED HERITAGE LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| BLACK INK BENEFITS3 Filed as: BLACK INK INSURANCE INC | 136 S 1ST W REXBURG, ID 83440 | LIFEMAP ASSURANCE COMPANY | $611 | — | $611 | 9.97% |
| MATTHEW B WALDRAM3 | PO BOX 2751 IDAHO FALLS, ID 83403 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $150 | — | $150 | 6.33% |
| DENISE A MAXWELL3 | 3501 W TORANA DR MERIDIAN, ID 83646 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 1.01% |
| MATTHEW B WALDRAM3 | PO BOX 2751 IDAHO FALLS, ID 83403 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $147 | — | $147 | 7.40% |
| DENISE A MAXWELL3 | 3501 W TORANA DR MERIDIAN, ID 83646 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | $4 | $24 | 1.21% |
| LYNSAY GROSS3 | 472 WEST CAGNEY DR MERIDIAN, ID 83646 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.25% |
| LOIS FLEENER3 | 3196 IVORY DRIVE IDAHO FALLS, ID 83401 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.15% |
| MATTHEW B WALDRAM3 | PO BOX 2751 IDAHO FALLS, ID 83403 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | — | $47 | 6.33% |
| DENISE A MAXWELL3 | 3501 W TORANA DR MERIDIAN, ID 83646 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.94% |
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 | 145 | 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) | 146 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 5 | $5K |
| Dental | DELTA DENTAL OF IDAHO | 133 | $61K |
| Vision | UNITED HERITAGE LIFE INSURANCE COMPANY | 116 | $12K |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 167 | $6K |
| Other(4 contracts, 2 carriers) | LIFEMAP ASSURANCE COMPANY | 167 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 167 | — |
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."
No prospect flags tripped on this filing.