| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 470 ATLANTIC AVENUE BOSTON, MA 02210 | UNITEDHEALTHCARE INSURANCE COMPANY | $64K | $0 | $64K | 2.29% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 15 SOUTH MAIN STREET, SUITE 900 GREENVILLE, SC 29601 | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | $9K | $0 | $9K | 3.89% |
| COMBINED SERVICES LLC3 Filed as: COMBINED SERVICES, LLC | PO BOX 1320 CONCORD, NH 03302 | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | $2K | $0 | $2K | 0.90% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 116 HUNTINGTON AVENUE BOSTON, MA 02216 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $11K | $0 | $11K | 6.58% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 400 MIDLAND DRIVE, SUITE 300 MOUNT LAUREL, NJ 08054 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 1.36% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $96 | $96 | 0.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 470 ATLANTIC AVENUE BOSTON, MA 02210 | EYEMED | $3K | $0 | $3K | 10.55% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 470 ATLANTIC AVENUE BOSTON, MA 02210 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $819 | $0 | $819 | 20.00% |
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 | 249 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 36 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 285 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 214 | $2.8M |
| Dental | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | 501 | $231K |
| Vision | EYEMED | 454 | $28K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 249 | $163K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 249 | $163K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 249 | $163K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 214 | $2.8M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 249 | $163K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 501 | — |
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.