| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 3805 WEST CHESTER PIKE, SUITE 200 NEWTON SQUARE, PA 19073 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $30K | $30K | 2.59% |
| ALLEVIARE LLC3 Filed as: ALLEVIARE, LLC | PO BOX 2586 CONCORD, NH 03302 | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | $4K | $0 | $4K | 0.51% |
| NEW HAMPSHIRE BANKERS SERVICES3 Filed as: NEW HAMPSHIRE BANKERS SERVICES, LLC | PO BOX 2586 CONCORD, NH 03302 | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | $2K | $0 | $2K | 0.23% |
| NEW HAMPSHIRE BANKERS SERVICES3 Filed as: NEW HAMPSHIRE BANKERS SERVICES, LLC | 2 EALE SQUARE, 2ND FLOOR CONCORD, NH 03302 | ANTHEM LIFE INSURANCE COMPANY | $47K | $0 | $47K | 11.21% |
| PO BOX 661193 | 3805 WEST CHESTER PIKE, SUITE 200 VIRGINIA BEACH, VA 23466 | ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC. | $0 | $1K | $1K | 1.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE RICHARDS GROUP EIN 03-0215988 CONSULTANT | Consulting (general) Service code 16 | — | $85K |
| MATTHEW THORNTON HEALTH PLAN, INC. EIN 02-0494919 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Other services Service code 12 | — | $69K |
| WIPFLI, LLP EIN 39-0758449 INDEPENDENT AUDITOR | Accounting (including auditing) Service code 10 | — | $40K |
| BERNSTEIN SHUR LEGAL SERVICES | Legal Service code 29 | 100 MIDDLE STREET WEST TOWER PORTLAND, ME 04101 | $35K |
| USI EIN 13-3771734 CONSULTANT | Consulting (general) Service code 16 | — | $31K |
| MASON & RICH, P.A. ACCOUNTING | Accounting (including auditing) Service code 10 | 6 BICENTENNIAL SQUARE CONCORD, NH 03301 | $14K |
| MDX MEDICAL INC DBA SAPPHIRE DIGL EIN 26-3441881 TECHNOLOGY | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $13K |
| BSWIFT ADMIN EIN 46-3306306 RECORDKEEPING | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $10K |
| NH BANKERS SERVICES EIN 20-8937557 COMMON MANAGEMENT | Other services Service code 49 | — | $10K |
| EBM EIN 46-3306306 RECORDKEEPING | Participant communication; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $7K |
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 | 536 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 548 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | 1,344 | $740K |
| Vision | ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC. | 1,066 | $71K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 536 | $418K |
| Short-term disability | ANTHEM LIFE INSURANCE COMPANY | 536 | $418K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 536 | $418K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 440 | $1.1M |
| Other | ANTHEM LIFE INSURANCE COMPANY | 536 | $418K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,344 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.