| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES (NY) LLC | 200 PARK AVENUE, 32ND FL NEW YORK, NY 10166 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $35K | — | $35K | 4.78% |
| COMBINED SERVICES LLC3 | 2 DELTA DR, STE 301 CONCORD, NH 03301 | UNITED OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 13.60% |
| ASSUREDPARTNERS3 Filed as: HACKETT VALINE AND MACDONALD INC | PO BOX 2127 SOUTH BURLINGTON, VT 05407 | UNITED OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 13.35% |
| COMBINED SERVICES LLC3 | 2 DELTA DR, STE 301 CONCORD, NH 03301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 13.66% |
| ASSUREDPARTNERS3 Filed as: HACKETT VALINE AND MACDONALD INC | PO BOX 2127 SOUTH BURLINGTON, VT 05407 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES (NY) LLC | 200 PARK AVENUE 32ND FL NEW YORK, NY 10166 | VISION SERVICE PLAN | $957 | — | $957 | 6.06% |
| ASSUREDPARTNERS3 Filed as: HACKETT VALINE AND MACDONALD INC. | PO BOX 2127 SOUTH BURLINGTON, VT 05407 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| COMBINED SERVICES LLC3 | 2 DELTA DR, STE 301 CONCORD, NH 03301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 14.38% |
| COMBINED SERVICES LLC3 Filed as: COMBINED SERVICES INC. | 2 DELTA DR, STE 301 CONCORD, NH 03301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $774 | $774 | 12.25% |
| ASSUREDPARTNERS3 Filed as: HACKETT VALINE AND MACDONALD INC | PO BOX 2127 SOUTTH BURLINGTON, VT 05407 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $632 | — | $632 | 10.00% |
| COMBINED SERVICES LLC3 | 2 DELTA DR, STE 301 CONCORD, NH 03301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $544 | $544 | 12.99% |
| ASSUREDPARTNERS3 Filed as: HACKETT VALINE AND MACDONALD INC | PO BOX 2127 SOUTH BURLINGTON, VT 05407 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $419 | — | $419 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $15K |
| CIGNA | Direct payment from the plan; Other services; Non-monetary compensation; Contract Administrator; Float revenue; Participant communication; Claims processing; Named fiduciary Service code 12 | — | $0 |
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 | 111 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 160 | $732K |
| Dental | DELTA DENTAL PLAN OF VERMONT, INC. | 232 | $148K |
| Vision(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 160 | $748K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 100 | $17K |
| Long-term disability | UNITED OMAHA LIFE INSURANCE COMPANY | 100 | $23K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 160 | $732K |
| Other(5 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 160 | $771K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 232 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.