| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PGIA, INC.3 | PO BOX 1388 BANGOR, ME 04402 | BLUE CROSS BLUE SHIELD OF RHODE ISLAND | $0 | $114K | $114K | 1.93% |
| STEVEN M SHUSTER3 Filed as: STEVEN M. SHUSTER | 12 OCEANSIDE PLAZA NARRAGANSETT, RI 02874 | BLUE CROSS BLUE SHIELD OF RHODE ISLAND | $0 | $1K | $1K | 0.02% |
| PGIA, INC.3 | 160 GOULD STREET, SUITE 122 NEEDHAM, MA 02494 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $12K | $0 | $12K | 4.24% |
| PGIA, INC.3 | 160 GOULD STREET, SUITE 122 NEEDHAM, MA 02494 | DELTA DENTAL OF RHODE ISLAND | $3K | $0 | $3K | 1.76% |
| PGIA, INC.3 | PO BOX 1388 BANGOR, ME 04402 | VISION SERVICE PLAN | $2K | $0 | $2K | 3.03% |
No Schedule C service providers reported on this filing.
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 | 243 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 245 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF RHODE ISLAND | 1,003 | $5.9M |
| Dental | DELTA DENTAL OF RHODE ISLAND | 419 | $178K |
| Vision | VISION SERVICE PLAN | 502 | $77K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 906 | $283K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 906 | $283K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF RHODE ISLAND | 1,003 | $5.9M |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 906 | $283K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,003 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.