| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NORTHERN BENEFITS3 Filed as: NORTHERN BENEFITS LTD | 1233 SHELBURNE ROAD SOUTH BURLINGTON, VT 05403 | BLUE CROSS AND BLUE SHIELD OF VERMONT | $56K | $9K | $65K | 3.55% |
| NORTHERN BENEFITS3 | 1233 SHELBURNE ROAD SOUTH BURLINGTON, VT 05403 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 1.81% |
| NORTHERN BENEFITS3 | 1233 SHELBURNE ROAD SOUTH BURLINGTON, VT 05403 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $715 | $715 | 1.81% |
| NORTHERN BENEFITS3 | 1233 SHELBURNE ROAD SOUTH BURLINGTON, VT 05403 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $847 | $847 | 2.69% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL PLAN OF VERMONT, INC. EIN 03-0219391 CLAIMS PROCESSING | Claims processing Service code 12 | 12 BACON STREET SUITE B BURLINGTON, VT 05401 | $17K |
| NORTHERN BENEFITS LTD EIN 03-0363039 BROKER | Insurance agents and brokers Service code 22 | 1233 SHELBURNE RD SUITE C2A SOUTH BURLINGTON, VT 05482 | $4K |
| COMBINED SERVICES EIN 02-0479434 BROKER | Insurance agents and brokers Service code 22 | 2 DELTA DRIVE SUITE 301 CONCORD, NH 03302 | $2K |
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 | 298 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 298 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF VERMONT | 298 | $1.8M |
| Vision | BLUE CROSS AND BLUE SHIELD OF VERMONT | 298 | $1.8M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 268 | $39K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 268 | $62K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 268 | $31K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF VERMONT | 298 | $1.8M |
| Other(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF VERMONT | 298 | $1.9M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 298 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.