| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE ARROWOOD GROUP3 | 9462 BROWNSBORO RD STE 146 LOUISVILLE, KY 40241 | DELTA DENTAL PLAN OF MAINE | $5K | — | $5K | 3.14% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 033021320 | DELTA DENTAL PLAN OF MAINE | $1K | — | $1K | 0.95% |
| TIMOTHY THOMPSON3 | 299 OCEAN HOUSE RD CAPE ELIZABETH, ME 04107 | DELTA DENTAL PLAN OF MAINE | $894 | — | $894 | 0.62% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ULTRABENEFITS, INC. EIN 04-3525752 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | PO BOX 763 WESTBORO, MA 01581 | $98K |
| PATIENT ADVOCATES LLC EIN 01-0525535 CASE MGMT | Other services Service code 49 | PO BOX 1959 GRAY, ME 04039 | $64K |
| TIMOTHY ROONEY EIN 40-5088182 INSURANCE BROKER | Insurance agents and brokers Service code 22 | 9462 BROWNSBORO RD STE 146 LOUISVILLE, KY 40241 | $45K |
| TIMOTHY THOMPSON EIN 51-6620172 INSURANCE BROKER | Insurance agents and brokers Service code 22 | 299 OCEAN HOUSE RD CAPE ELIZABETH, ME 041072432 | $45K |
| FIRST HEALTH GROUP CORP EIN 20-1736437 PPO NETWORK | Other services Service code 49 | PO BOX 23517 SAN DIEGO, CA 921230517 | $17K |
| MEDICAL NETWORK, INC. EIN 01-0417576 PPO NETWORK | Other services Service code 49 | TEN PLAZA DRIVE STE 203 SCARBOROUGH, ME 04074 | $15K |
| CAREMARK EIN 75-2882129 PRESCRIPTION SERVICES | Other services Service code 49 | PO BOX 848001 DALLAS, TX 752848001 | $7K |
| PREMIER HEALTHCARE EXCHANGE EIN 86-1040704 CLAIMS COST NEGOTIATOR | Other services Service code 49 | 2 CROSSROADS DRIVE BEDMINSTER, NJ 079211562 | $0 |
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 | 299 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL PLAN OF MAINE | 434 | $144K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE | 299 | $449K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 434 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.