| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE, LLC. | PO BOX 1788 GRAND RAPIDS, MI 49501 | DELTA DENTAL PLAN OF VERMONT, INC. | $5K | — | $5K | 3.93% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 364 SHELBURNE ROAD BURLINGTON, VT 05401 | RELIANCE STANDARD | $4K | $628 | $4K | 13.14% |
| COMBINED SERVICES LLC3 | 2 DELTA DRIVE SUITE 301 CONCORD, NH 03301 | RELIANCE STANDARD | $2K | $0 | $2K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 364 SHELBURNE ROAD BURLINGTON, VT 05401 | RELIANCE STANDARD | $2K | $629 | $3K | 9.60% |
| COMBINED SERVICES LLC3 | 2 DELTA DRIVE SUITE 301 CONCORD, NH 03301 | RELIANCE STANDARD | $2K | $0 | $2K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC. | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | VISION SERVICE PLAN | $1K | — | $1K | 4.77% |
| GROUP BENEFITS LTD3 Filed as: GROUP BENEFITS, LTD. | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | VISION SERVICE PLAN | $1K | — | $1K | 3.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS AND BLUE SHIELD OF VT EIN 03-0277307 CONTRACT ADMINISTRATOR | Claims processing; Insurance services; Contract Administrator Service code 12 | — | $170K |
| ACRISURE, LLC. BROKER | Insurance brokerage commissions and fees Service code 53 | — | $50K |
| INTERFLEX PAYMENTS, LLC. EIN 27-2256926 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $4K |
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 | 314 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 314 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL PLAN OF VERMONT, INC. | 317 | $131K |
| Vision | VISION SERVICE PLAN | 133 | $29K |
| Life insurance | RELIANCE STANDARD | 289 | $30K |
| Long-term disability | RELIANCE STANDARD | 180 | $32K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS AND BLUE SHIELD OF VERMONT | 314 | $721K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 317 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.