| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF MA | 144 TURNPIKE ROAD SOUTHBOROUGH, MA 01772 | COMPANION LIFE | $21K | — | $21K | 5.00% |
| ACADIA BENEFITS INC3 | 50 PORTLAND PIER SUITE 301 PORTLAND, ME 04101 | DELTA DENTAL PLAN OF MAINE | $5K | — | $5K | 3.87% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 033021320 | DELTA DENTAL PLAN OF MAINE | $1K | — | $1K | 0.98% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF MA | 144 TURNPIKE ROAD STE 330 SOUTHBOROUGH, MA 01772 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 10.08% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ULTRABENEFITS, INC. EIN 04-3525752 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | PO BOX 763 WESTBORO, MA 01581 | $22K |
| 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 | $16K |
| PATIENT ADVOCATES LLC EIN 01-0372148 CASE MGMT | Other services Service code 49 | PO BOX 1959 GRAY, ME 04039 | $9K |
| STRATEGIC BENEFIT ADVISORS EIN 27-4732361 PRODUCER | Insurance agents and brokers Service code 22 | 144 TURNPIKE ROADSTE 330 SOUTHBOROUGH, MA 01772 | $9K |
| ZELIS EIN 86-1040704 CLAIMS REVIEW SERVICE | Other services Service code 49 | 2 CROSSROADS DRIVE BEDMINSTER, NJ 07921 | $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 | 248 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 248 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL PLAN OF MAINE | 361 | $141K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 180 | $15K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE | 248 | $426K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 361 | — |
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.