| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PROVIDER INSURANCE GROUP, LLC3 Filed as: PROVIDER INSURANCE GROUP LLC | 160 GOULD ST STE 130 NEEDHAM, MA 02494 | UNITEDHEALTHCARE INSURANCE COMPANY | $40K | — | $40K | 9.99% |
| PROVIDER INSURANCE GROUP, LLC3 Filed as: PROVIDER INSURANCE GROUP | 160 GOULD ST., STE 130 NEEDHAM, MA 02494 | DELTA DENTAL OF RHODE ISLAND | $5K | — | $5K | 2.20% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE DBA PROVIDERS INS. | PO BOX 1388 BANGOR, ME 04402 | DELTA DENTAL OF RHODE ISLAND | $966 | — | $966 | 0.46% |
| PROVIDER INSURANCE GROUP, LLC3 | PO BOX 1388 BANGOR, ME 04402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 9.35% |
| PROVIDER INSURANCE GROUP, LLC3 Filed as: PROVIDER INSURANCE GROUP LLC | 160 GOULD ST STE 130 NEEDHAM, MA 02494 | UNITEDHEALTHCARE INSURANCE COMPANY | $4K | — | $4K | 9.98% |
| PROVIDER INSURANCE GROUP, LLC3 | PO BOX 1388 BANGOR, ME 04402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 15.00% |
| PROVIDER INSURANCE GROUP, LLC3 Filed as: PROVIDER INSURANCE GROUP | 160 GOULD ST., STE 130 NEEDHAM, MA 02494 | DELTA DENTAL OF RHODE ISLAND | $15 | — | $15 | 2.24% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE DBA PROVIDER INS. | PO BOX 1388 BANGOR, ME 04402 | DELTA DENTAL OF RHODE ISLAND | $3 | — | $3 | 0.45% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | 9900 BREN ROAD EAST MINNETONKA, MN 55343 | $209K |
| PROVIDER INSURANCE GROUP LLC EIN 27-2005964 BROKER | Other commissions Service code 55 | 160 GOULD ST STE 130 NEEDHAM, MA 02494 | $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 | 398 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 398 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | UNITEDHEALTHCARE INSURANCE COMPANY | 583 | $447K |
| Dental(2 contracts) | DELTA DENTAL OF RHODE ISLAND | 603 | $210K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 394 | $66K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 394 | $66K |
| Stop-loss / reinsurancereinsurance(2 contracts) | UNITEDHEALTHCARE INSURANCE COMPANY | 583 | $447K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 394 | $74K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 603 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.