| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HICKOK & BOARDMAN FINANCIAL3 | PO BOX 1064 BURLINGTON, VT 05402 | SUN LIFE ASSURANCE COMPANY OF CANADA | $14K | — | $14K | 9.20% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK AND BOARDMAN FINANCIAL PL. | 346 SHELBURNE RD 5TH FLOOR BURLINGTON, VT 05401 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $2K | $4K | 4.10% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK AND BOARDMAN FINANCIAL PL. | 346 SHELBURNE RD 5TH FLOOR BURLINGTON, VT 05401 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $500 | $5K | 16.75% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK AND BOARDMAN FINANCIAL PL | 346 SHELBURNE RD 5TH FLOOR BURLINGTON, VT 05401 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $29 | — | $29 | 3.05% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK AND BOARDMAN FINANCIAL PL | 346 SHELBURNE RD 5TH FLOOR BURLINGTON, VT 05401 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $1K | — | $1K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TOWERS WATSON DELAWARE, INC EIN 53-0181291 ACTUARY | Actuarial Service code 11 | — | $33K |
| MCSOLEY MCCOOY AND CO. EIN 03-0327374 AUDITOR | Accounting (including auditing) Service code 10 | 1585 BROADWAY 37TH FLOOR NEW YORK, NY 10036 | $8K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 210 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 210 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 203 | $89K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 203 | $88K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 320 | $153K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 203 | $118K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 320 | — |
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.