| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLACK INK BENEFITS3 | 2240 E 25TH ST IDAHO FALLS, ID 83402 | STEALTH | $57K | — | $57K | 12.75% |
| BALLARD INSURANCE GROUP LLC3 | 147 N 2ND E, STE 1 REXBURG, ID 83440 | DELTA DENTAL OF IDAHO | $9K | — | $9K | 2.35% |
| ROD FURNISS EMPLOYEE BENEFITS3 | 2240 E 25TH ST IDAHO FALLS, ID 83404 | DELTA DENTAL OF IDAHO | $2K | — | $2K | 0.59% |
| ROD FURNISS EMPLOYEE BENEFITS3 | 136 S 1ST W REXBURG, ID 83440 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | — | $12K | 3.97% |
| MATTHEW B WALDRAM3 | P.O. BOX 2751 IDAHO FALLS, ID 83403 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 2.62% |
| ROD FURNISS EMPLOYEE BENEFITS3 | 136 S 1ST W REXBURG, ID 83440 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | — | $12K | 9.99% |
| MATTHEW B WALDRAM3 | P.O. BOX 2751 IDAHO FALLS, ID 83403 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | — | $10K | 8.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK INK SOLUTIONS | 2240 E 25TH ST IDAHO FALLS, ID 83402 | WILLAMETTE DENTAL GROUP | $4K | — | $4K | 4.13% |
| BALLARD INSURANCE GROUP LLC3 | 147 N 2ND E STE 1 REXBURG, ID 83440 | WILLAMETTE DENTAL GROUP | $643 | — | $643 | 0.63% |
| CARLOS APONTE3 | 136 S 1ST W REXBURG, ID 834401817 | VISION SERVICE PLAN | $3K | — | $3K | 2.90% |
| JAMES H. VAN EPPS3 Filed as: JAMES H VAN EPPS | 10930 CRABAPPLE RD STE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 20.77% |
| MATTHEW B WALDRAM3 | P.O. BOX 2751 IDAHO FALLS, ID 83403 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 17.88% |
| CHARLES D. BLOCK3 Filed as: CHARLES D BLOCK | 648 VILLAGE PARK DR UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 10.82% |
| STEVEN RAY GRIFFIN3 | 2000 MORRIS AVE STE 1400 BIRMINGHAM, AL 35203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $181 | — | $181 | 0.52% |
| JAMES H. VAN EPPS3 Filed as: JAMES H VAN EPPS | 10930 CRABAPPLE RD STE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 27.99% |
| MATTHEW B WALDRAM3 | P.O. BOX 2751 IDAHO FALLS, ID 83403 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 24.08% |
| CHARLES D. BLOCK3 Filed as: CHARLES D BLOCK | 648 VILLAGE PARK DR UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 16.40% |
| STEVEN RAY GRIFFIN3 | 2000 MORRIS AVE STE 1400 BIRMINGHAM, AL 35203 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $102 | — | $102 | 0.84% |
| MATTHEW B WALDRAM3 | P.O. BOX 2751 IDAHO FALLS, ID 83403 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 21.00% |
| MATTHEW B WALDRAM3 | P.O. BOX 2751 IDAHO FALLS, ID 83403 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $255 | — | $255 | 16.43% |
| DENISE A MAXWELL3 | 4948 KOOTENAI ST. BOISE, ID 83705 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $34 | $16 | $50 | 3.22% |
| ROD FURNISS EMPLOYEE BENEFITS3 | 2240 E 25TH ST IDAHO FALLS, ID 83404 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | $0 | $27 | 1.74% |
| WILLIAM KEZELE3 | P.O. BOX 5597 TWIN FALLS, ID 83303 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
| VIRGINIA KEZELE3 | 15007 W PINCHOT AVE. GOODYEAR, AZ 85395 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
| ZINA OSTER3 | 3153 FOREST DR CHEYENNE, WY 82001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
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 | 787 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 787 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF IDAHO | 379 | $470K |
| Vision | VISION SERVICE PLAN | 460 | $87K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 787 | $445K |
| Short-term disability(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 787 | $318K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 787 | $312K |
| Stop-loss / reinsurancereinsurance | STEALTH | 518 | $443K |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 787 | $467K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 787 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.