| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLARK MORTENSON AGENCY3 Filed as: CLARK-MORTENSON AGENCY INC | 102 MAIN STREET PO BOX 606 KEENE, NH 03431 | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | $4K | — | $4K | 4.33% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: COMBINED SERVIES LLC DBA CSONE BENE | PO BOX 1320 CONCORD, NH 033021320 | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | $1K | — | $1K | 1.04% |
| CLARK MORTENSON AGENCY3 | 102 MAIN STREET KEENE, NH 03431 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5K | — | $5K | 5.63% |
| JOSEPH P. ANDREWS3 Filed as: JOSEPH P ANDREWS | 86 NASHUA RD #1311 LONDONDERRY, NH 03053 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 1.79% |
| EMPLOYEE BENEFIT CONSULTANTS3 | C/O COLONIAL LIFE INS CO PORTLAND, ME 04101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $43 | $1K | 1.34% |
| MICHELLE MUELLER LEA3 | 11510 GRAMERCY PARK AVE BRADENTON, FL 34211 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $68 | $13 | $81 | 0.09% |
| CORCORAN & HOYT LLC3 | 3905 TAMPA ROAD OLDSMAR, FL 34677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $74 | — | $74 | 0.08% |
| ROBERT S. TAPPAN3 Filed as: ROBERT S TAPPAN | 300 OHIO AVE MANCHESTER, NH 03104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $56 | — | $56 | 0.06% |
| K&P BENEFITS CONSULTING GROUP3 Filed as: K&P BENEFITS CONSULTING GROUP INC | 7020 PROFESSIONAL PKWY EAST SARASOTA, FL 34240 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.02% |
| COLLETTE G BOISVERT3 | 349 CENTRAL STREET MANCHESTER, NH 03103 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.02% |
| ARBER SINANI3 | 6932 EXETER PARK PLACE APOLLO BEACH, FL 33572 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $10 | $12 | 0.01% |
| FLEURY ENTERPRISES INC3 | 162 INDIAN POINT RD TIVERTON, RI 02878 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.01% |
| RICHARD HASKINS3 | 22 WEST STREET MILLBURY, MA 01527 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.01% |
| JUSTIN M REYNOLDS3 | 11905 PERSIAN TERRACE BRANDENTON, FL 34212 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $3 | $5 | 0.01% |
| SHIRLEY B DRAKE3 | 14141 46TH STREET N CLEARWATER, FL 33762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.00% |
| WORKSITE AMERICA LLC3 | 14141 46TH STREET NORTH CLEARWATER, FL 33762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.00% |
| CLARK MORTENSON AGENCY3 | PO BOX 606 KEENE, NH 034310606 | VISION SERVICE PLAN | $983 | — | $983 | 5.95% |
| CLARK MORTENSON AGENCY3 | 102 MAIN STREET KEENE, NH 03431 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 11.95% |
| CLARK MORTENSON AGENCY3 Filed as: CLARK-MORTENSON | 102 MAIN STREET KEENE, NH 03431 | EMPLOYEE ASSISTANCE GROUP | $306 | — | $306 | 5.00% |
| CLARK MORTENSON AGENCY3 | 102 MAIN STREET KEENE, NH 03431 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $322 | — | $322 | 12.01% |
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 | 194 | 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) | 194 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPLOYEE ASSISTANCE GROUP | 208 | $6K |
| Dental | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | 283 | $99K |
| Vision | VISION SERVICE PLAN | 136 | $17K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 176 | $108K |
| Other(3 contracts, 3 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 208 | $101K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 283 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.