| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 346 SHELBURNE ROAD 5TH FLOOR BURLINGTON, VT 05401 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $27K | $27K | 2.62% |
| HICKOK & BOARDMAN FINANCIAL3 | 346 SHELBURNE ROAD 5TH FLOOR BURLINGTON, VT 05401 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | -$96 | -$96 | -0.01% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | DELTA DENTAL PLAN OF VERMONT, INC. | $3K | — | $3K | 4.96% |
| COMBINED SERVICES LLC3 Filed as: COMBINED SERVICES LLC DBA | CSONE BENEFIT SOLUTIONS PO BOX 1320 CONCORD, NH 03302 | DELTA DENTAL PLAN OF VERMONT, INC. | $539 | — | $539 | 0.83% |
| ACRISURE LLC3 | HICKOK AND BOARDMAN 364 SHELBURNE RD BURLINGTON, VT 05401 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 11.53% |
| ACRISURE LLC3 | HICKOK AND BOARDMAN 364 SHELBURNE RD BURLINGTON, VT 05401 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 8.08% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK & BOARDMAN FIN PLANNING | PO BOX 1064 BURLINGTON, VT 05401 | STANDARD INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | VISION SERVICE PLAN | $807 | — | $807 | 6.99% |
| GROUP BENEFITS LTD3 Filed as: GROUP BENEFITS, LTD. | 12006 RIDGEMONT DR URBANDALE, IA 50323 | VISION SERVICE PLAN | $181 | — | $181 | 1.57% |
| HICKOK & BOARDMAN FINANCIAL3 Filed as: HICKOK & BOARDMAN FIN PLANNING | PO BOX 1064 BURLINGTON, VT 05402 | VISION SERVICE PLAN | -$2 | — | -$2 | -0.02% |
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 | 149 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 150 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 143 | $1.0M |
| Dental | DELTA DENTAL PLAN OF VERMONT, INC. | 206 | $65K |
| Vision | VISION SERVICE PLAN | 85 | $12K |
| Life insurance | STANDARD INSURANCE COMPANY | 136 | $12K |
| Short-term disability | STANDARD INSURANCE COMPANY | 118 | $24K |
| Long-term disability | STANDARD INSURANCE COMPANY | 117 | $31K |
| Other | STANDARD INSURANCE COMPANY | 136 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 206 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.