| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMWINS5 Filed as: AMWINS GROUP BENEFITS | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | HARTFORD LIFE & ACCIDENT INS CO. MEDICARE SUPPLEMENT | $20K | — | $20K | 7.78% |
| NFP INSURANCE SERVICES INC5 Filed as: NFP CORPORATE SERVICES | 620 HINESBURG RD SOUTH BURLINGTON, VT 05403 | HARTFORD LIFE & ACCIDENT INS CO. MEDICARE SUPPLEMENT | $9K | — | $9K | 3.33% |
| COMBINED SERVICES LLC3 | DBA CSONE BENEFIT SOLUTIONS P.O. BOX 1320 CONCORD, NH 03302 | NORTHEAST DELTA DENTAL | $735 | — | $735 | 0.59% |
| NFP INSURANCE SERVICES INC5 Filed as: NFP CORPORATE SERVICES | 340 MADISON AVE NEW YORK, NY 10173 | UNUM LIFE INSRUANCE COMPANY OF AMERICA | $4K | $2K | $6K | 6.27% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INS CO. EIN 59-1031071 MED CLAIMS ADM SVCS | Non-monetary compensation; Float revenue; Participant communication; Direct payment from the plan; Named fiduciary; Claims processing; Contract Administrator; Other services Service code 12 | P.O. BOX 644546 PITTSBURGH, PA 15264 | $15.5M |
| ANNE HOULE EIN 03-0210827 KEY EMPLOYEE SALARY | Employee (plan sponsor); Plan Administrator; Insurance services Service code 14 | P.O. BOX 345 BARRE, VT 05641 | $81K |
| DANIELLE DOHERTY EIN 03-0210827 EMPLOYEE SALARY | Recordkeeping and information management (computing, tabulating, data processing, etc.); Employee (plan sponsor) Service code 15 | P.O. BOX 345 BARRE, VT 05641 | $53K |
| NFP CORPORATE SERVICES EIN 51-0434666 AGENT BROKER | Insurance brokerage commissions and fees Service code 53 | 340 MADISON AVE 21ST FLR 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 | 763 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 148 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 911 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HARTFORD LIFE & ACCIDENT INS CO. MEDICARE SUPPLEMENT | 141 | $261K |
| Dental | NORTHEAST DELTA DENTAL | 301 | $124K |
| Vision | VISION SERVICE PLAN | 267 | $25K |
| Life insurance | UNUM LIFE INSRUANCE COMPANY OF AMERICA | 283 | $90K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 763 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 763 | — |
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.