| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NORTHERN BENEFITS3 | 1233 SHELBURNE ROAD SOUTH BURLINGTON, VT 05403 | BLUE CROSS AND BLUE SHIELD OF VERMONT | $51K | $5K | $56K | 2.58% |
| NORTHERN BENEFITS3 | 1233 SHELBURNE ROAD SOUTH BURLINGTON, VT 05403 | MUTUAL OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 2.28% |
| NORTHERN BENEFITS3 | 1233 SHELBURNE ROAD SOUTH BURLINGTON, VT 05403 | MUTUAL OF OMAHA LIFE INSURANCE COMPANY | — | $931 | $931 | 2.07% |
| NORTHERN BENEFITS3 | 1233 SHELBURNE ROAD SOUTH BURLINGTON, VT 05403 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $743 | $743 | 2.22% |
| 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 | $21K |
| NORTHERN BENEFIT LTD EIN 03-0363039 BROKER | Insurance agents and brokers Service code 22 | 1233 SHELBURNE ROAD SOUTH BURLINGTON, VT 05403 | $4K |
| COMBINED SERVICES, LLC EIN 02-0479434 BROKER | Insurance agents and brokers Service code 22 | 2 DELTA DRIVE SUITE 301 CONCORD, NH 03302 | $1K |
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 | 641 | 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) | 641 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF VERMONT | 431 | $2.2M |
| Vision | BLUE CROSS AND BLUE SHIELD OF VERMONT | 431 | $2.2M |
| Life insurance | MUTUAL OF OMAHA LIFE INSURANCE COMPANY | 641 | $45K |
| Short-term disability | MUTUAL OF OMAHA LIFE INSURANCE COMPANY | 604 | $65K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 641 | $33K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF VERMONT | 431 | $2.2M |
| Other(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF VERMONT | 641 | $2.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 641 | — |
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.