| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANDREW M ROBERTS3 | 210 HUMPHREY ST., STE. 107 MARBLEHEAD, MA 01945 | DELTA DENTAL OF RHODE ISLAND | $2K | — | $2K | 5.38% |
| AMR BENEFITS MANAGEMENT, LLC3 Filed as: AMR BENEFITS MANAGEMENT LLC | 210 HUMPHREY ST., STE. 107 MARBLEHEAD, MA 01945 | EYEMED VISION CARE | $582 | — | $582 | 9.95% |
| AMR BENEFITS MANAGEMENT, LLC3 Filed as: AMR BENEFITS MANAGEMENT LLC | 210 HUMPHREY ST., STE. 107 MARBLEHEAD, MA 01945 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $674 | — | $674 | 12.33% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF NEW ENGLAND LLC | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $147 | — | $147 | 2.69% |
| AMR BENEFITS MANAGEMENT, LLC3 Filed as: AMR BENEFITS MANAGEMENT LLC | 210 HUMPHREY ST., STE. 107 MARBLEHEAD, MA 01945 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $382 | — | $382 | 8.14% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF NEW ENGLAND LLC | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $87 | — | $87 | 1.85% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PATIENT ADVOCATES LLC TPA | Contract Administrator; Claims processing; Other services; Participant communication Service code 12 | 235 PORTLAND ROAD GRAY, ME 04039 | $39K |
| AMR BENEFITS BROKER | Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 210 HUMPHREY STREET SUITE 107 MARBLEHEAD, MA 01945 | $16K |
| MULTIPLAN TPA | Claims processing; Contract Administrator Service code 12 | 115 FIFTH AVENUE NEW YORK, NY 10003 | $3K |
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 | 107 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 107 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF RHODE ISLAND | 92 | $38K |
| Vision | EYEMED VISION CARE | 73 | $6K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 107 | $10K |
| Stop-loss / reinsurancereinsurance | HCC TOKIO MARINE | 38 | $126K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 107 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 107 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.