| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 364 SHELBOURNE ROAD BURLINGTON, VT 05401 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $9K | $4K | $13K | 8.95% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INSURANCE AGENCY INC | PO BOX 948 HENRIETTA, NY 14467 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | $0 | $4K | 2.92% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | DELTA DENTAL PLAN OF VERMONT, INC. | $2K | $0 | $2K | 3.72% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX AGENCY INC | 225 KENNETH DRIVE ROCHESTER, NY 14623 | DELTA DENTAL PLAN OF VERMONT, INC. | $743 | $0 | $743 | 1.19% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 03302 | DELTA DENTAL PLAN OF VERMONT, INC. | $555 | $0 | $555 | 0.89% |
| ACRISURE LLC3 Filed as: ACRILSURE, LLC | 346 SHELBURNE ROAD, 5TH FLOOR BURLINGON, VT 05401 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $341 | $0 | $341 | 2.47% |
| MICHAEL PATRICK MCGARRY3 | 9 DUNN ESTATES SCARBOROUGH, ME 04074 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $320 | $0 | $320 | 2.32% |
| ACRISURE LLC3 | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | VISION SERVICE PLAN | $736 | $0 | $736 | 6.90% |
| GROUP BENEFITS LTD3 Filed as: GROUP BENEFITS, LTD | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | VISION SERVICE PLAN | $586 | $0 | $586 | 5.50% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX AGENCY INC | PO BOX 948 HENRIETTA, NY 14467 | VISION SERVICE PLAN | $181 | $0 | $181 | 1.70% |
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 | 112 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL PLAN OF VERMONT, INC. | 149 | $62K |
| Vision | VISION SERVICE PLAN | 65 | $11K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 112 | $142K |
| Short-term disability(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 112 | $156K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 112 | $142K |
| Other(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 112 | $156K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 149 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.