| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMWINS5 | 50 WHITECAP DRIVE NORTH KINGSTON, RI 02582 | HARTFORD LIFE AND ACCIDENT INS CO MEDICARE SUPPLEMENT | $20K | — | $20K | 8.27% |
| WEB TPA5 | 8500 FREEPORT PKYWY SOUTH IRVING, TX 75063 | HARTFORD LIFE AND ACCIDENT INS CO MEDICARE SUPPLEMENT | $15K | — | $15K | 6.28% |
| NFP INSURANCE SERVICES INC5 Filed as: NFP CORPORATE SERVICES (NY) LLC | 340 MADISON AVE 21ST FLR NEW YORK, NY 10173 | HARTFORD LIFE AND ACCIDENT INS CO MEDICARE SUPPLEMENT | $8K | — | $8K | 3.54% |
| COMBINED SERVICES LLC3 | P.O. BOX 1320 CONCORD, NH 03302 | NORTHEAST DELTA DENTAL | $981 | — | $981 | 0.77% |
| NFP INSURANCE SERVICES INC5 Filed as: NFP INSURANCE SERVICES | 340 MADISON AVE 21ST FL NEW YORK, NY 10173 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $1K | $5K | 7.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH LIFE INSURANCE CO EIN 59-1031071 MEDICAL CLAIMS ADMIN SVC | Participant communication; Float revenue; Claims processing; Non-monetary compensation; Contract Administrator; Named fiduciary; Other services; Direct payment from the plan Service code 12 | P.O. BOX 644546 PITTSBURGH, PA 15264 | $9.5M |
| ANNE HOULE EIN 03-0210827 SALARY FOR KEY EMPLOYEE | Plan Administrator; Employee (plan sponsor); Insurance services Service code 14 | P.O. BOX 345 BARRE, VT 05641 | $74K |
| DANIELLE DOHERTY EIN 03-0210827 SALARY FOR EMPLOYEE | Employee (plan sponsor); Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | P.O. BOX 345 BARRE, VT 05641 | $19K |
| ANN REGAN EIN 03-0210827 SALARY FOR EMPLOYEE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Employee (plan sponsor) Service code 15 | P.O. BOX 345 BARRE, VT 05641 | $17K |
| NFP INSURANCE SERVICES INC EIN 51-0434666 | Insurance brokerage commissions and fees Service code 53 | 340 MADISON AVE. 21ST FL NEW YORK, NY 10173 | $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 | 540 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 166 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 706 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HARTFORD LIFE AND ACCIDENT INS CO MEDICARE SUPPLEMENT | 159 | $239K |
| Dental | NORTHEAST DELTA DENTAL | 503 | $127K |
| Vision | VISION SERVICE PLAN | 229 | $26K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 0 | $73K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH LIFE INSURANCE COMPANY | 1,018 | $747K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,018 | — |
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."
No prospect flags tripped on this filing.