| 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 | 4.13% |
| 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. | $82 | — | $82 | 0.08% |
| CLARK MORTENSON AGENCY3 | 102 MAIN STREET KEENE, NH 03431 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 4.36% |
| JOSEPH P. ANDREWS3 Filed as: JOSEPH P ANDREWS | 86 NASHUA RD #1311 LONDONDERRY, NH 03053 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 2.00% |
| EMPLOYEE BENEFIT CONSULTANTS3 | C/O COLONIAL LIFE INS CO PORTLAND, ME 04101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $708 | $51 | $759 | 0.90% |
| CORCORAN & HOYT LLC3 | 3905 TAMPA ROAD OLDSMAR, FL 34677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $86 | — | $86 | 0.10% |
| ROBERT S. TAPPAN3 Filed as: ROBERT S TAPPAN | 300 OHIO AVE MANCHESTER, NH 03104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $65 | — | $65 | 0.08% |
| COLLETTE G BOISVERT3 | 349 CENTRAL STREET MANCHESTER, NH 03103 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $48 | — | $48 | 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 | $38 | — | $38 | 0.04% |
| MICHELLE MUELLER LEA3 | 6070 BRANDON RUN BRADENTON, FL 34211 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | $0 | $27 | 0.03% |
| FLEURY ENTERPRISES INC3 | 162 INDIAN POINT RD TIVERTON, RI 02878 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.02% |
| RICHARD HASKINS3 | 22 WEST STREET MILLBURY, MA 01527 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.01% |
| WORKSITE AMERICA LLC3 Filed as: WORKSITE AMERICAN LLC | 14141 46TH STREET NORTH CLEARWATER, FL 33762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | $0 | $4 | 0.00% |
| SHIRLEY B DRAKE3 | 14141 46TH STREET N CLEARWATER, FL 33762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.00% |
| CLARK MORTENSON AGENCY3 | PO BOX 606 KEENE, NH 034310606 | VISION SERVICE PLAN | $839 | — | $839 | 5.49% |
| CLARK MORTENSON AGENCY3 | 102 MAIN STREET KEENE, NH 03431 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 11.07% |
| CLARK MORTENSON AGENCY3 Filed as: CLARK-MORTENSON | 102 MAIN STREET KEENE, NH 03431 | EMPLOYEE ASSISTANCE GROUP | $280 | — | $280 | 4.99% |
| CLARK MORTENSON AGENCY3 | 102 MAIN STREET KEENE, NH 03431 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $246 | — | $246 | 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 | 171 | 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) | 171 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPLOYEE ASSISTANCE GROUP | 186 | $6K |
| Dental | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | 263 | $104K |
| Vision | VISION SERVICE PLAN | 129 | $15K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 165 | $97K |
| Other(3 contracts, 3 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 186 | $92K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 263 | — |
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.