| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $14K | — | $14K | 4.58% |
| ACRISURE LLC3 | 364 SHELBURNE ROAD BURLINGTON, VT 05401 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $6K | $6K | $12K | 4.01% |
| COMBINED SERVICES LLC3 | 2 DELTA DRIVE SUITE 301 CONCORD, NH 03301 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $501 | $501 | 0.17% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $13K | — | $13K | 4.58% |
| ACRISURE LLC3 | 364 SHELBURNE ROAD BURLINGTON, VT 05401 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $7K | $5K | $12K | 4.38% |
| COMBINED SERVICES LLC3 | 2 DELTA DRIVE SUITE 301 CONCORD, NH 03301 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $460 | $460 | 0.17% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $7K | — | $7K | 4.61% |
| ACRISURE LLC3 | 364 SHELBURNE ROAD BURLINGTON, VT 05401 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | $3K | $6K | 4.47% |
| COMBINED SERVICES LLC3 | 2 DELTA DRIVE SUITE 301 CONCORD, NH 03301 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $225 | $225 | 0.16% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA | HICKOK BOARDMAN HR INTELLIGENCE 346 SHELBURNE ROAD BURLINGTON, VT 05401 | EYEMED VISION CARE | $7K | — | $7K | 9.94% |
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 | 1,079 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,085 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL PLAN OF VERMONT, INC. | 1,376 | $628K |
| Vision | EYEMED VISION CARE | 879 | $66K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,078 | $145K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,078 | $301K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,078 | $277K |
| Other(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,078 | $173K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,376 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.