| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TIMOTHY ROONEY3 | 9462 BROWNSBORO RD STE 146 LOUISVILLE, KY 40241 | DELTA DENTAL PLAN OF MAINE | $2K | — | $2K | 1.61% |
| TIMOTHY THOMPSON3 | 299 OCEAN HOUSE RD CAPE ELIZABETH, ME 04107 | DELTA DENTAL PLAN OF MAINE | $2K | — | $2K | 1.61% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 033021320 | DELTA DENTAL PLAN OF MAINE | $1K | — | $1K | 0.97% |
| ACADIA BENEFITS INC3 | 111 COMMERCIAL ST 5TH FL PORTLAND, ME 04101 | DELTA DENTAL PLAN OF MAINE | $806 | — | $806 | 0.61% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ULTRABENEFITS, INC. EIN 04-3525752 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | PO BOX 763 WESTBORO, MA 01581 | $66K |
| TIMOTHY ROONEY EIN 40-5088182 INSURANCE BROKER | Insurance agents and brokers Service code 22 | 9462 BROWNSBORO RD STE 146 LOUISVILLE, KY 40241 | $46K |
| TIMOTHY THOMPSON EIN 51-6620172 INSURANCE BROKER | Insurance agents and brokers Service code 22 | 299 OCEAN HOUSE RD CAPE ELIZABETH, ME 041072432 | $46K |
| PHILLIP E. SOULE EIN 35-2425050 PRODUCER | Insurance agents and brokers Service code 22 | 309 WIANNO AVE OSTERVILLE, MA 02655 | $19K |
| FIRST HEALTH EIN 20-1736437 PPO NETWORK | Other services Service code 49 | PO BOX 30719 LOS ANGELES, CA 900300719 | $18K |
| ZELIS EIN 86-1040704 CLAIMS REVIEW SERVICE | Other services Service code 49 | 2 CROSSROADS DRIVE BEDMINSTER, NJ 07921 | $14K |
| PATIENT ADVOCATES LLC EIN 01-0372148 CASE MGMT | Other services Service code 49 | PO BOX 1959 GRAY, ME 04039 | $9K |
| NATIONAL BILL AUDIT SERVICES EIN 20-0091768 CLAIMS AUDITOR | Claims processing Service code 12 | 5999 CENTRAL AVE SUITE 401 ST PETERSBURG, FL 33710 | $6K |
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 | 297 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 297 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL PLAN OF MAINE | 395 | $132K |
| Stop-loss / reinsurancereinsurance | US FIRE INSURANCE COMPANY | 297 | $393K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 395 | — |
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.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.