| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK & BOARDMAN | PO BOX 1064 BURLINGTON, VT 05402 | DELTA DENTAL PLAN OF VERMONT, INC. | $4K | — | $4K | 4.91% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 03302 | DELTA DENTAL PLAN OF VERMONT, INC. | $942 | — | $942 | 1.18% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK & BOARDMAN | PO BOX 1064 BURLINGTON, VT 05402 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 12.22% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK & BOARDMAN | PO BOX 1064 BURLINGTON, VT 05402 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 9.59% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK & BOARDMAN | PO BOX 1064 BURLINGTON, VT 05402 | VISION SERVICE PLAN | $1K | — | $1K | 5.59% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 364 SHELBOURNE RD. BURLINGTON, VT 05401 | RELIANCE STANDARD | $594 | — | $594 | 15.01% |
| COMBINED SERVICES LLC3 Filed as: COMBINED SERVICES, LLC | 2 DELTA DRIVE SUITE 301 CONCORD, NH 03301 | RELIANCE STANDARD | $198 | — | $198 | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 364 SHELBOURNE RD. BURLINGTON, VT 05401 | RELIANCE STANDARD | $367 | — | $367 | 10.99% |
| COMBINED SERVICES LLC3 | 2 DELTA DRIVE SUITE 301 CONCORD, NH 03301 | RELIANCE STANDARD | $167 | — | $167 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF VERMONT EIN 03-0277307 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator; Insurance services Service code 12 | — | $102K |
| HICKOK AND BOARDMAN BROKER | Insurance brokerage commissions and fees Service code 53 | PO BOX 1064 BURLINGTON, VT 05402 | $35K |
| INTERFLEX PAYMENTS, LLC EIN 27-2256926 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $3K |
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 | 245 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 245 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL PLAN OF VERMONT, INC. | 243 | $80K |
| Vision | VISION SERVICE PLAN | 113 | $19K |
| Life insurance(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 203 | $25K |
| Short-term disability(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 203 | $25K |
| Long-term disability(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 195 | $32K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 245 | $483K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 245 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.