| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOCK & BOARDMAN FINANCIAL | PO BOX 1064 BURLINGTON, VT 05402 | CIGNA | $55K | — | $55K | 9.15% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK & BOARDMAN FIN PLANNING | 346 SHELBURNE ROAD PO BOX 1064 SHELBURNE, VT 054011064 | DELTA DENTAL PLAN OF VT INC. | $8K | $0 | $8K | 1.98% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 033021320 | DELTA DENTAL PLAN OF VT INC. | $3K | $0 | $3K | 0.66% |
| HICKOK & BOARDMAN FINANCIAL3 | P.O. BOX 1064 BURLINGTON, VT 05402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | $0 | $10K | 4.44% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK & BOARDMAN INC. | P.O. BOX 1064 BURLINGTON, VT 05402 | UNUM LIFE INSURANCE COMPANY | $5K | $0 | $5K | 4.44% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK & BOARDMAN FINANCIAL PLANNIN | P.O. BOX 1064 BURLINGTON, VT 05402 | UNUM LIFE INSURANCE COMPANY | $2K | $0 | $2K | 1.90% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK & BOARDMAN FINANCIAL L. | PLANNING AND GROUP BENEFITS INC PO BOX 1064 BURLINGTON, VT 054021064 | VISION SERVICE PLAN | $2K | $0 | $2K | 3.81% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK AND BOARDMAN INC. | P.O. BOX 1064 BURLINGTON, VT 054021064 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $0 | $6K | 16.17% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK AND BOARDMAN FINANCIAL PLANN | P.O. BOX 1064 BURLINGTON, VT 05402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $668 | $0 | $668 | 1.89% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA BEHAVIORAL HEALTH EIN 41-1648670 CONTRACT ADMINISTRATOR | Participant communication; Claims processing; Other services; Float revenue; Direct payment from the plan; Non-monetary compensation; Contract Administrator Service code 12 | — | $194K |
| UNUM LIFE INSURANCE COMPANY OF AMER EIN 01-0278678 CONTRACT ADMIN. | Contract Administrator Service code 13 | — | $11K |
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 | 803 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 803 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL PLAN OF VT INC. | 803 | $386K |
| Vision | VISION SERVICE PLAN | 201 | $48K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 367 | $266K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY | 372 | $120K |
| Stop-loss / reinsurancereinsurance | CIGNA | 700 | $600K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 367 | $266K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 803 | — |
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.