| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ADVANCED BENEFIT INC3 | 2448 NORTH MERRIT CREEK LOOP COUER D ALENE, ID 83814 | PACIFIC SOURCE HEALTH PLANS | $10K | $0 | $10K | 0.97% |
| ALLIANT INSURANCE SERVICES, INC.3 | 2448 NORTH MERRITT CREEK LOOP COUER D ALENE, ID 83814 | PACIFIC SOURCE HEALTH PLANS | $9K | $0 | $9K | 0.90% |
| BLACK INK BENEFITS3 Filed as: BLACK INK INSURANCE INC | 309 PROFIT STREET, UNITE 1104 REXBURG, ID 83440 | PACIFIC SOURCE HEALTH PLANS | $5K | $0 | $5K | 0.45% |
| MEGAN R SILVERMAN3 Filed as: MEGAN SILVERMAN | 1423 MARTIN MEADOWS DRIVE FALLSTON, MD 21047 | NATIONWIDE | $14K | $0 | $14K | 13.87% |
| BLACK INK BENEFITS3 Filed as: BLACK INK INSURANCE, INC. | 136 SOUTH 1ST WEST REXBURG, ID 83440 | NATIONWIDE | $6K | $0 | $6K | 5.95% |
| ERIN M. SILVERMAN3 | 1423 MARTIN MEADOWS DRIVE FALLSTON, MD 21047 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $210 | $6K | 18.09% |
| CARLOS APONTE3 Filed as: CARLOS A. APONTE | 355 PARTRIDGE LANE REXBURG, ID 83440 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 2.96% |
| BLACK INK BENEFITS3 Filed as: BLACK INK INSURANCE, INC. | 136 SOUTH 1ST WEST REXBURG, ID 83440 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $971 | $0 | $971 | 2.70% |
| NATIONAL BENEFIT PARTNER WEST LLC3 Filed as: NATIONAL BENEFIT PARTNER WEST, LLC | 99 WOOD AVENUE SOUTH, SUITE 501 ISELIN, NJ 08830 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $718 | $718 | 2.00% |
| CARLOS APONTE3 Filed as: CARLOS A. APONTE | 309 PROFIT STREET, UNITE 1104 REXBURG, ID 83440 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $662 | $0 | $662 | 1.84% |
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 | 63 | 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) | 63 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFIC SOURCE HEALTH PLANS | 82 | $1.0M |
| Dental | NATIONWIDE | 119 | $102K |
| Vision | NATIONWIDE | 119 | $102K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 63 | $36K |
| Prescription drug | PACIFIC SOURCE HEALTH PLANS | 82 | $1.0M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 63 | $36K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 119 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.