| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLARK INSURANCE3 | — | HARVARD PILGRIM HEALTH CARE | $3K | — | $3K | 0.28% |
| CLARK INSURANCE3 | 1945 CONGRESS STREET BUILDING A PO BOX 3543 PORTLAND, ME 04104 | DELTA DENTAL PLAN OF MAINE | $4K | — | $4K | 5.00% |
| COMBINED SERVICES LLC3 Filed as: COMBINED SERVICES LLC DBA CSONE | PO BOX 1320 CONCORD, NH 03302 | DELTA DENTAL PLAN OF MAINE | $719 | — | $719 | 0.85% |
| CLARK INSURANCE3 | — | HARVARD PILGRIM HEALTH CARE | $55 | — | $55 | 0.28% |
| CLARK INSURANCE3 | PO BOX 3543 PORTLAND, ME 04104 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 11.49% |
| CLARK INSURANCE3 | 1945 CONGRESS STREET BUILDING A PORTLAND, ME 04102 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $899 | — | $899 | 10.51% |
| CLARK INSURANCE3 | 1945 CONGRESS STREET BUILDING A PORTLAND, ME 04102 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $438 | — | $438 | 10.77% |
| CLARK INSURANCE3 | — | HARVARD PILGRIM HEALTH CARE | $8 | — | $8 | 0.28% |
| CLARK INSURANCE3 | 1945 CONGRESS STREET BUILDING A PORTLAND, ME 04102 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $11 | — | $11 | 26.19% |
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 | 117 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 118 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts) | HARVARD PILGRIM HEALTH CARE | 187 | $1.2M |
| Dental | DELTA DENTAL PLAN OF MAINE | 199 | $85K |
| Vision(3 contracts) | FIDELITY SECURITY LIFE INSURANCE COMPANY | 64 | $13K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 117 | $86K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 117 | $68K |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 117 | $97K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 199 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.