| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLACK INK BENEFITS3 | 2240 E 25TH STREET IDAHO FALLS, ID 83402 | STEALTH | $72K | — | $72K | 9.92% |
| INTERMOUNTAIN INSURANCE SERVICES3 | 136 S 1ST W REXBURG, ID 83440 | DELTA DENTAL OF IDAHO | $15K | — | $15K | 3.00% |
| CASTLE LAKE INSURANCE LLC3 | P.O. BOX 2751 IDAHO FALLS, ID 83403 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 2.32% |
| INTERMOUNTAIN INSURANCE SERVICES3 | 136 S 1ST W REXBURG, ID 83440 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 2.32% |
| CASTLE LAKE INSURANCE LLC3 | P.O. BOX 2751 IDAHO FALLS, ID 83403 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | — | $12K | 7.50% |
| INTERMOUNTAIN INSURANCE SERVICES3 | 136 S 1ST W REXBURG, ID 83440 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | — | $12K | 7.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK INK SOLUTIONS | 2240 E 25TH ST IDAHO FALLS, ID 83402 | WILLAMETTE DENTAL GROUP | $6K | — | $6K | 5.00% |
| CARLOS APONTE3 | 136 S 1ST W REXBURG, ID 834401817 | VISION SERVICE PLAN | $3K | — | $3K | 2.78% |
| STEVEN RAY GRIFFIN3 | 2000 MORRIS AVE STE 1400 BIRMINGHAM, AL 35203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $26K | — | $26K | 32.06% |
| MATTHEW B WALDRAM3 | PO BOX 2751 IDAHO FALLS, ID 83403 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 8.00% |
| CHARLES D. BLOCK3 Filed as: CHARLES D BLOCK | 648 VILLAGE PARK DR UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 6.00% |
| EMPLOYEE FAMILY PROTECTION INC3 | PO BOX 1237 GLASTONBURY, CT 06033 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 5.11% |
| INTERMOUNTAIN INSURANCE SERVICES3 | 136 S 1ST W REXBURG, ID 83440 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 4.84% |
| JAMES H. VAN EPPS3 Filed as: JAMES H VAN EPPS | 10930 CRABAPPLE RD STE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 4.00% |
| CASTLE LAKE INSURANCE LLC3 | P.O. BOX 2751 IDAHO FALLS, ID 83403 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $201 | — | $201 | 0.24% |
| STEVEN RAY GRIFFIN3 | 2000 MORRIS AVE STE 1400 BIRMINGHAM, AL 35203 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $16K | — | $16K | 50.83% |
| MATTHEW B WALDRAM3 | PO BOX 2751 IDAHO FALLS, ID 83403 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 10.86% |
| CHARLES D. BLOCK3 Filed as: CHARLES D BLOCK | 648 VILLAGE PARK DR, UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 8.49% |
| INTERMOUNTAIN INSURANCE SERVICES3 | 136 S 1ST W REXBURG, ID 83440 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 7.85% |
| JAMES H. VAN EPPS3 Filed as: JAMES H VAN EPPS | 10930 CRABAPPLE RD STE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 3.89% |
| EMPLOYEE FAMILY PROTECTION INC3 | PO BOX 1237 GLASTONBURY, CT 06033 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $197 | — | $197 | 0.63% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: CASTLE LAKE INSRUANCE LLC | PO BOX 2751 IDAHO FALLS, ID 83403 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $91 | — | $91 | 0.29% |
| MATTHEW B WALDRAM3 | P.O. BOX 2751 IDAHO FALLS, ID 83403 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $753 | — | $753 | 14.99% |
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 | 863 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 863 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF IDAHO | 522 | $630K |
| Vision | VISION SERVICE PLAN | 496 | $112K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 863 | $484K |
| Short-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 863 | $297K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 863 | $292K |
| Stop-loss / reinsurancereinsurance | STEALTH | 580 | $729K |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 863 | $536K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 863 | — |
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.