| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | BLUE CROSS BLUE SHIELD OF RHODE ISLAND | $4K | $21K | $25K | 2.30% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | DELTA DENTAL OF RHODE ISLAND | $5K | — | $5K | 2.00% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $7K | $12K | 12.13% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | 6.91% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $12K | $4K | $16K | 26.98% |
| FMLASOURCE INC5 | 455 N. CITYFRONT PLZ. DR., 13TH FL. CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $9K | $9K | 15.35% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | DELTA DENTAL OF RHODE ISLAND | $3K | — | $3K | 10.00% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 16.89% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INS. CO EIN 59-1031071 TPA | Contract Administrator; Claims processing; Participant communication; Other services Service code 12 | — | $151K |
| HILB GROUP OF NEW ENGLAND BROKER | Other commissions; Insurance agents and brokers Service code 22 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | $67K |
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 | 448 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 451 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF RHODE ISLAND | 614 | $1.1M |
| Dental | DELTA DENTAL OF RHODE ISLAND | 796 | $253K |
| Vision | DELTA DENTAL OF RHODE ISLAND | 691 | $35K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 448 | $157K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 280 | $32K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 285 | $64K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 448 | $99K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 796 | — |
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.