| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $475 | $3K | 18.49% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $792 | $278 | $1K | 13.51% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $717 | $252 | $969 | 13.52% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 22.60% |
| R FINE & R FINE INS LLC3 Filed as: R FINE & R FINE INS. LLC | 390 MAIN ST.,STE. 524 WORCESTER, MA 01608 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $12 | — | $12 | 0.22% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | EYEMED VISION CENTER CARE OBO FIDELITY SECURITY LIFE INSURANCE COMPANY | $184 | — | $184 | 10.37% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTH PLANS INC. EIN 04-2734278 TPA | Other services; Claims processing Service code 12 | — | $67K |
| HILB GROUP OF NEW ENGLAND BROKER | Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | 2000 CHAPEL VIEW BLVD. STE.240 CRANSTON, RI 02920 | $30K |
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 | 100 | 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) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 63 | $5K |
| Vision | EYEMED VISION CENTER CARE OBO FIDELITY SECURITY LIFE INSURANCE COMPANY | 23 | $2K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 100 | $8K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 100 | $7K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 100 | $14K |
| Stop-loss / reinsurancereinsurance | PROSELECT INSURANCE COMPANY DBA COVERYS | 47 | $169K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 100 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 100 | — |
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.