| 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 | 3.83% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 364 SHELBURNE ROAD BURLINGTON, VT 05401 | RELIANCE STANDARD | $4K | — | $4K | 10.66% |
| COMBINED SERVICES LLC3 Filed as: COMBINED SERVICES LIMITED LIABILITY | 2 DELTA DRIVE SUITE 301 CONCORD, NH 03301 | RELIANCE STANDARD | $2K | — | $2K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 364 SHELBURNE ROAD BURLINGTON, VT 05401 | RELIANCE STANDARD | $2K | — | $2K | 7.67% |
| COMBINED SERVICES LLC3 Filed as: COMBINED SERVICES LIMITED LIABILITY | 2 DELTA DRIVE SUITE 301 CONCORD, NH 03301 | RELIANCE STANDARD | $1K | — | $1K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | VISION SERVICE PLAN | $1K | — | $1K | 5.13% |
| GROUP BENEFITS LTD3 Filed as: GROUP BENEFITS, LTD. | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | VISION SERVICE PLAN | $909 | — | $909 | 4.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CBA BLUE CONTRACT ADMINISTRATOR | Claims processing; Insurance services; Contract Administrator Service code 12 | PO BOX 2365 SOUTH BURLINGTON, VT 05407 | $121K |
| ACRISURE, LLC. BROKER | Insurance brokerage commissions and fees Service code 53 | 346 SHELBURNE ROAD 5TH FLOOR BURLINGTON, VT 05402 | $42K |
| 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 | 163 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 163 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL PLAN OF VERMONT, INC. | 279 | $118K |
| Vision | VISION SERVICE PLAN | 112 | $23K |
| Life insurance | RELIANCE STANDARD | 276 | $27K |
| Long-term disability | RELIANCE STANDARD | 229 | $35K |
| Stop-loss / reinsurancereinsurance | HCC | 163 | $830K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 279 | — |
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.