| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBA BLUE5 | PO BOX 2365 SOUTH BURLINGTON, VT 05407 | EASTERN BENEFITS GROUP | — | $561K | $561K | 65.12% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK&BOARDMAN FINANCIAL | 346 SHELBURNE RD BURLINGTON, VT 05401 | EASTERN BENEFITS GROUP | — | $110K | $110K | 12.79% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK&BOARDMAN FIN PLNG &GRP 1 | 346 SHELBURNE RD FL 6 BURLINGTON, VT 05401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $36K | — | $36K | 10.00% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK&BOARDMAN FIN PLNG &GRP 1 | 346 SHELBURNE RD FL 6 BURLINGTON, VT 05401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $36K | — | $36K | 15.00% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK&BOARDMAN FIN PLNG &GRP 1 | 346 SHELBURNE RD FL 6 BURLINGTON, VT 05401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $23K | — | $23K | 10.00% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK&BOARDMAN FIN PLNG &GRP 1 | 346 SHELBURNE RD BURLINGTON, VT 05401 | VISION SERVICE PLAN | — | $33K | $33K | 19.00% |
| HICKOK & BOARDMAN FINANCIAL Filed as: HICKOK&BOARDMAN FIN PLNG &GRP 1 | 346 SHELBURNE RD BURLINGTON, VT 05401 | UNUM LIFE INSURANCE | $9K | — | $9K | 6.35% |
| HICKOK & BOARDMAN FINANCIAL Filed as: HICKOK&BOARDMAN FIN PLNG &GRP 1 | 346 SHELBURNE RD BURLINGTON, VT 05401 | UNUM LIFE INSURANCE | $14K | — | $14K | 15.56% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK&BOARDMAN FIN PLNG &GRP 1 | 346 SHELBURNE RD BURLINGTON, VT 05401 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $4K | — | $4K | 9.19% |
| UNITED OF OMAHA LIFE INSURANCE CO Filed as: MUTUTAL OF OMAHA INSURANCE COMPANY | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | MUTUAL OF OMAHA INSURANCE COMPANY | $5K | — | $5K | 15.00% |
| HICKOK & BOARDMAN FINANCIAL Filed as: HICKOK&BOARDMAN FIN PLNG &GRP 1 | 346 SHELBURNE RD BURLINGTON, VT 05401 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $534 | — | $534 | 8.85% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK&BOARDMAN FIN PLNG &GRP 1 | 346 SHELBURNE RD BURLINGTON, VT 05401 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $534 | — | $534 | 8.85% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK&BOARDMAN FIN PLNG &GRP 1 | 346 SHELBURNE RD BURLINGTON, VT 05401 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $471 | $471 | 8.00% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK&BOARDMAN FIN PLNG &GRP 1 | 346 SHELBURNE RD FL 6 BURLINGTON, VT 05401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $13K | $15K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CBA BLUE | Contract Administrator Service code 13 | PO BOX 2365 SOUTH BURLINGTON, VT 05407 | $52K |
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 | 1,822 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 145 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,967 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 2 carriers) | EASTERN BENEFITS GROUP | 1,372 | $922K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 5 | $49K |
| Vision | VISION SERVICE PLAN | 1,420 | $173K |
| Life insurance(6 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,489 | $752K |
| Short-term disability | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 5 | $6K |
| Long-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,460 | $367K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,460 | $284K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,489 | — |
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.