| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HICKOK & BOARDMAN FINANCIAL3 | PLANNING 346 SHELBURNE ROAD, 5TH FLOOR BURLINGTON, VT 05401 | MVP HEALTH CARE | $27K | — | $27K | 1.99% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK & BOARDMAN FIN PLAN & | GRP BENEFITS INC PO BOX 1064 BURLINGTON, VT 054011064 | DELTA DENTAL PLAN OF VERMONT, INC. | $4K | — | $4K | 3.61% |
| COMBINED SERVICES LLC3 Filed as: COMBINED SERVICES LCC | DBA CSONE BENEFIT SOLUTIONS PO BOX 1320 CONCORD, NH 033021320 | DELTA DENTAL PLAN OF VERMONT, INC. | $1K | — | $1K | 0.85% |
| HICKOK & BOARDMAN FINANCIAL3 | PLANNING 346 SHELBURNE ROAD, 5TH FLOOR BURLINGTON, VT 05401 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 9.40% |
| HICKOK & BOARDMAN FINANCIAL3 | PLANNING 346 SHELBURNE ROAD, 5TH FLOOR BURLINGTON, VT 05401 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 9.42% |
| HICKOK & BOARDMAN FINANCIAL3 | PLANNING 346 SHELBURNE ROAD, 5TH FLOOR BURLINGTON, VT 05401 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $426 | — | $426 | 15.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA GROVE INSURANCE ADMIN SERVICES | Insurance services Service code 23 | PO BOX 20643 LEHIGH VALLEY, PA 180020643 | $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 | 241 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 244 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MVP HEALTH CARE | 175 | $1.3M |
| Dental | DELTA DENTAL PLAN OF VERMONT, INC. | 300 | $123K |
| Vision | MVP HEALTH CARE | 175 | $1.3M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 244 | $21K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 244 | $45K |
| Prescription drug | MVP HEALTH CARE | 175 | $1.3M |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 244 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 300 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.