| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMWINS5 Filed as: AMWINS GROUP BENEFITS LLC | 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 SUITE# 200 SOUTH BURLINGTON, VT 05403 | HARTFORD LIFE & ACCIDENT INS CO. MEDICARE SUPPLEMENT | $9K | — | $9K | 3.33% |
| NFP INSURANCE SERVICES INC5 Filed as: NFP CORPORATE SERVICES | 340 MADISON AVE 21ST FLR NEW YORK, NY 10173 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $2K | $6K | 6.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 MEDICAL CLAIMS ADM SVCS | Float revenue; Claims processing; Participant communication; Other services; Named fiduciary; Non-monetary compensation; Direct payment from the plan; Contract Administrator Service code 12 | P.O. BOX 644546 PITTSBURGH, PA 15264 | $17.1M |
| ANNE HOULE EIN 03-0210827 KEY EMPLOYEE SALARY | Insurance services; Plan Administrator; Employee (plan sponsor) Service code 14 | P.O. BOX 345 BARRE, VT 05641 | $75K |
| DANIELLE DOHERTY EIN 03-0210827 EMPLOYEE SALARY | Employee (plan sponsor); Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | P.O. BOX 345 BARRE, VT 05641 | $58K |
| NFP CORPORATE SERVICES EIN 51-0434666 INSURANCE AGENT,BROKER | Insurance brokerage commissions and fees Service code 53 | 340 MADISON AVE 21ST FLOOR 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 | 731 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 138 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 869 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HARTFORD LIFE & ACCIDENT INS CO. MEDICARE SUPPLEMENT | 131 | $258K |
| Dental | NORTHEAST DELTA DENTAL | 483 | $125K |
| Vision | VISION SERVICE PROVIDER | 258 | $26K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 292 | $97K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,334 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,334 | — |
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.