| 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. | $4K | — | $4K | 4.38% |
| COMBINED SERVICES LLC3 Filed as: COMBINED SERVICES LIMITED LIABILITY | 2 DELTA DRIVE SUITE 301 CONCORD, NH 03301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $6K | $6K | 8.85% |
| ACRISURE LLC3 | 364 SHELBURNE ROAD BURLINGTON, VT 05401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 6.54% |
| ACRISURE LLC3 | 364 SHELBURNE ROAD BURLINGTON, VT 05401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 11.12% |
| COMBINED SERVICES LLC3 Filed as: COMBINED SERVICES LIMITED LIABILITY | 2 DELTA DRIVE SUITE 301 CONCORD, NH 03301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 8.85% |
| ACRISURE LLC3 | 364 SHELBURNE ROAD BURLINGTON, VT 05401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| COMBINED SERVICES LLC3 | 2 DELTA DRIVE SUITE 301 CONCORD, NH 03301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 8.85% |
| ACRISURE LLC3 | 364 SHELBURNE RD BURLINGTON, VT 05401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| COMBINED SERVICES LLC3 Filed as: COMBINED SERVICES LIMITED LIABILITY | 2 DELTA DR STE 301 CONCORD, NH 03301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 8.88% |
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | VISION SERVICE PLAN | $936 | — | $936 | 6.14% |
| GROUP BENEFITS LTD3 Filed as: GROUP BENEFITS, LTD | 12006 RIDGEMONT DR URBANDALE, IA 50323 | VISION SERVICE PLAN | $609 | — | $609 | 4.00% |
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 | 181 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 181 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL PLAN OF VERMONT, INC. | 120 | $81K |
| Vision | VISION SERVICE PLAN | 100 | $15K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 174 | $33K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 174 | $68K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 174 | $32K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 174 | $33K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 174 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.