| 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 | $2K | — | $2K | 2.10% |
| CASTLE LAKE INSURANCE LLC3 Filed as: CASTLE LAKE INSURANCE, LLC | PO BOX 2751 IDAHO FALLS, IA 83403 | DELTA DENTAL OF IDAHO | $647 | — | $647 | 0.90% |
| MATTHEW B WALDRAM3 Filed as: MATTHEW WALDRAM | 1601 ANTLER DR IDAHO FALLS, ID 834041226 | UNITED HERITAGE LIFE INSURANCE COMPANY | $1K | — | $1K | 9.67% |
| BLACK INK BENEFITS3 Filed as: BLACK INK INSURANCE INC | 136 S 1ST W REXBURG, ID 83440 | LIFEMAP ASSURANCE COMPANY | $684 | — | $684 | 9.81% |
| MATTHEW B WALDRAM3 | 1601 ANTLER DR IDAHO FALLS, ID 83404 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $183 | — | $183 | 7.32% |
| DENISE A MAXWELL3 | 3501 W TORANA DR MERIDIAN, ID 83646 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $29 | $2 | $31 | 1.24% |
| GABRIEL APONTE3 | 136 S 1ST W REXBURG, ID 83440 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.40% |
| LYNSAY GROSS3 | 472 WEST CAGNEY DR MERIDIAN, ID 83646 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.16% |
| LOIS FLEENER3 | 3196 IVORY DRIVE IDAHO FALLS, ID 83401 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.04% |
| MATTHEW B WALDRAM3 | 1601 ANTLER DR IDAHO FALLS, ID 83404 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $230 | — | $230 | 9.87% |
| DENISE A MAXWELL3 | 3501 W TORANA DR MERIDIAN, ID 83646 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | $5 | $31 | 1.33% |
| LYNSAY GROSS3 | 472 WEST CAGNEY DR MERIDIAN, ID 83646 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.64% |
| LOIS FLEENER3 | 3196 IVORY DRIVE IDAHO FALLS, ID 83401 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.30% |
| MATTHEW B WALDRAM3 | 1601 ANTLER DR IDAHO FALLS, ID 83404 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $94 | — | $94 | 8.96% |
| GABRIEL APONTE3 | 136 S 1ST W REXBURG, ID 83440 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | — | $33 | 3.15% |
| DENISE A MAXWELL3 | 3501 W TORANA DR MERIDIAN, ID 83646 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | $5 | $21 | 2.00% |
| LYNSAY GROSS3 | 472 WEST CAGNEY DR MERIDIAN, ID 83646 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.76% |
| LOIS FLEENER3 | 3196 IVORY DRIVE IDAHO FALLS, ID 83401 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.19% |
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 | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 168 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 5 | $6K |
| Dental | DELTA DENTAL OF IDAHO | 151 | $72K |
| Vision | UNITED HERITAGE LIFE INSURANCE COMPANY | 125 | $14K |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 184 | $7K |
| Other(4 contracts, 2 carriers) | LIFEMAP ASSURANCE COMPANY | 184 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 184 | — |
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.