| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HICKOK & BOARDMAN FINANCIAL3 | PO BOX 1064 BURLINGTON, VT 054021064 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $3K | $3K | 0.36% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | DELTA DENTAL PLAN OF VERMONT, INC. | $3K | $0 | $3K | 3.08% |
| COMBINED SERVICES LLC3 Filed as: COMBINED SERVICES, LLC | PO BOX 1320 CONCORD, NH 033021320 | DELTA DENTAL PLAN OF VERMONT, INC. | $967 | $0 | $967 | 0.90% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK & BOARDMAN FIN PLAN & GRP | 346 SHELBURNE ROAD PO BOX 1064 BURLINGTON, VT 054021064 | DELTA DENTAL PLAN OF VERMONT, INC. | $674 | $0 | $674 | 0.63% |
| ACRISURE LLC3 | 364 SHELBURNE RD BURLINGTON, VT 05401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $0 | $5K | 11.69% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK & BOARDMAN FIN PLNG & GRP 1 | 346 SHELBURNE RD. FLOOR 5 BURLINGTON, VT 054014935 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 6.17% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA HICKOK & BOARDMAN | 346 SHELBURNE RD FLOOR 5 BURLINGTON, VT 05401 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | $0 | $4K | 13.00% |
| ACRISURE LLC3 | 2625 W PETERSON AVE CHICAGO, IL 606594004 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $75 | $75 | 0.27% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK & BOARDMAN FIN. PLANNING | PO BOX 1064 BURLINGTON, VT 054021064 | VISION SERVICE PLAN | $475 | $0 | $475 | 2.62% |
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 | 284 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 286 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 249 | $900K |
| Dental | DELTA DENTAL PLAN OF VERMONT, INC. | 225 | $107K |
| Vision | VISION SERVICE PLAN | 127 | $18K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 64 | $72K |
| Short-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 64 | $72K |
| Long-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 64 | $72K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 249 | $900K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 64 | $44K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 249 | — |
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.