| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLARK INSURANCE3 | 1945 CONGRESS STREET BUILDING A PO BOX 3543 PORTLAND, ME 04104 | DELTA DENTAL PLAN OF MAINE | $4K | — | $4K | 5.40% |
| COMBINED SERVICES LLC3 Filed as: COMBINED SERVICES LLC DBA CSONE | PO BOX 1320 CONCORD, NH 03302 | DELTA DENTAL PLAN OF MAINE | $753 | — | $753 | 0.96% |
| CLARK INSURANCE3 | 1945 CONGRESS STREET BUILDING A PORTLAND, ME 04102 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | — | $1K | 9.15% |
| CLARK INSURANCE3 | PO BOX 3543 PORTLAND, ME 04104 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 25.95% |
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 | 121 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HARVARD PILGRIM HEALTH CARE | 203 | $836K |
| Dental | DELTA DENTAL PLAN OF MAINE | 200 | $79K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 78 | $12K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 118 | $91K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 118 | $75K |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 118 | $99K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 203 | — |
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.