| 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 | $20K | — | $20K | 5.00% |
| ACADIA BENEFITS INC3 | 50 PORTLAND PIER SUITE 301 PORTLAND, ME 04101 | DELTA DENTAL PLAN OF MAINE | $4K | — | $4K | 3.82% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 033021320 | DELTA DENTAL PLAN OF MAINE | $100 | — | $100 | 0.09% |
| 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 | $1K | — | $1K | 9.09% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ULTRABENEFITS, INC. EIN 04-3525752 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | PO BOX 763 WESTBORO, MA 01581 | $59K |
| PHILLIP E. SOULE EIN 35-2425050 PRODUCER | Insurance agents and brokers Service code 22 | 309 WIANNO AVE OSTERVILLE, MA 02655 | $18K |
| FIRST HEALTH EIN 20-1736437 PPO NETWORK | Other services Service code 49 | PO BOX 30719 LOS ANGELES, CA 900300719 | $15K |
| AMERCIAN HEALTH HOLDINGS EIN 31-1368946 CASE MGMT | Other services Service code 49 | 7400 W CAMPUS RD F510 NEW ALBANY, OH 43054 | $12K |
| STRATEGIC BENEFIT ADVISORS EIN 27-4732361 PRODUCER | Insurance agents and brokers Service code 22 | 144 TURNPIKE ROADSTE 330 SOUTHBOROUGH, MA 01772 | $8K |
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 | 250 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 250 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL PLAN OF MAINE | 364 | $117K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 203 | $14K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE | 250 | $397K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 364 | — |
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."
No prospect flags tripped on this filing.