| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MOUNTAIN STATES | PO BOX 5815 BOISE, ID 83705 | PACIFIC SOURCE HEALTH PLANS | $18K | — | $18K | 2.62% |
| VARIOUS - SEE ATTACHED3 | — | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $9K | — | $9K | 31.06% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MOUNTAIN STATES | 400 E 1ST STREET SUITE 105 CASPER, WY 82601 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | — | $2K | 11.65% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL LIMITED | 150 N RIVERSIDE PLZ, STE 1700 CHICAGO, IL 60606 | PRINCIPAL LIFE INSURANCE COMPANY | — | $477 | $477 | 2.26% |
| GIFFORD TROY3 | 5369 N ISLA AVE MERIDIAN, ID 83646 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $362 | — | $362 | 28.87% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MOUNTAIN STATES | PO BOX 2158 RIVERSIDE, CA 92516 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $126 | — | $126 | 10.05% |
| UNKNOWN3 | — | DELTA DENTAL PLAN OF IDAHO INC | $0 | — | $0 | — |
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 | 124 | 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) | 124 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFIC SOURCE HEALTH PLANS | 140 | $695K |
| Dental | DELTA DENTAL PLAN OF IDAHO INC | 124 | $0 |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 234 | $21K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 234 | $21K |
| Short-term disability(2 contracts) | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 37 | $31K |
| Other(2 contracts) | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 37 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 234 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.