| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $28K | $28K | 3.20% |
| ALLEVIARE LLC3 Filed as: ALLEVIARE, LLC | PO BOX 2586 CONCORD, NH 03302 | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | $5K | $0 | $5K | 0.75% |
| COMBINED SERVICES LLC3 Filed as: COMBINED SERVICES, LLC | PO BOX 1320 CONCORD, NH 03302 | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | $163 | $0 | $163 | 0.02% |
| NEW HAMPSHIRE BANKERS SERVICES3 | PO BOX 2586 CONCORD, NH 03302 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $45K | $0 | $45K | 10.37% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $0 | $24K | $24K | 5.64% |
| HPHC INSURANCE AGENCY, INC.3 | 93 WORCESTER STREET WELLESLEY HILLS, VA 02481 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5 | $0 | $5 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| USI EIN 13-3771734 CONSULTANT | Consulting (general) Service code 16 | — | $95K |
| MATTHEW THORNTON HEALTH PLAN, INC. EIN 02-0494919 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $92K |
| BERNSTEIN SHUR LEGAL SERVICES | Legal Service code 29 | 100 MIDDLE STREET WEST TOWER PORTLAND, ME 04101 | $40K |
| WIPFLI, LLP EIN 39-0758449 INDEPENDENT AUDIT | Accounting (including auditing) Service code 10 | — | $39K |
| MASON + RICH, P.A. ACCOUNTING | Accounting (including auditing) Service code 10 | 6 BICENTENNIAL SQUARE CONCORD, NH 03301 | $18K |
| EBM EIN 46-3306306 RECORDKEEPING | Recordkeeping and information management (computing, tabulating, data processing, etc.); Participant communication Service code 15 | — | $9K |
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 | 741 | 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) | 741 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | 1,431 | $710K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 124 | $433K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 124 | $433K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 124 | $433K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 124 | $433K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 502 | $862K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 124 | $433K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,431 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.