| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NOYLE W JOHNSON INC3 | PO BOX 279 MONTPELIER, VT 05601 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 4.57% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NORTHEAST DELTA DENTAL EIN 03-0219391 NONE | Claims processing Service code 12 | ONE DELTA DENTAL PO BOX 2002 CONCORD, NH 03302 | $62K |
| GRIPPIN DONLAN & PINKHAM, PLC EIN 03-0354347 NONE | Accounting (including auditing) Service code 10 | 3 BALDWIN AVENUE SOUTH BURLINGTON, VT 05403 | $24K |
| VERMONT AUTO DEALERS ASSOC. INC. EIN 03-0213537 PLAN SPONSOR | Plan Administrator Service code 14 | PO BOX 747 MONTELPIER, VT 05601 | $19K |
| UNUM LIFE INS. CO. OF AMERICA EIN 01-0278678 NONE | Insurance services Service code 23 | PO BOX 406955 ATLANTA, GA 30384 | $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 | 1,668 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,669 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,668 | $74K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,668 | $74K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,668 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.