| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMWINS5 | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | TRANSAMERICA INSURANCE CO. | $27K | — | $27K | 11.90% |
| WEB TPA5 | 8500 FREEPORT PKWY SOUTH IRVING, TX 75063 | TRANSAMERICA INSURANCE CO. | $10K | — | $10K | 4.60% |
| ACRISURE LLC5 | P.O. BOX 1788 GRAND RAPIDS, MI 49501 | TRANSAMERICA INSURANCE CO. | $3K | — | $3K | 1.50% |
| AMWINS5 Filed as: AMWINS GROUP BENEFITS LLC | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | EXPRESS SCRIPTS, INC. | $27K | — | $27K | 25.54% |
| ACRISURE LLC5 | P.O. BOX 1788 GRAND RAPIDS, MI 49501 | EXPRESS SCRIPTS, INC. | $9K | — | $9K | 8.51% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TITO ANTONELLI EIN 20-2366635 RETIREE | Trustee (directed) Service code 25 | — | $15K |
| PEASE BELL CPAS, LLC EIN 36-4267431 ACCOUNTANT/AUDITOR | Accounting (including auditing) Service code 10 | — | $13K |
| BENEFITS ADMINISTRATIVE SERVICES CO EIN 34-1627054 ADMINISTRATION | Contract Administrator Service code 13 | — | $10K |
| MARK DELONG EIN 20-2366635 RETIREE | Trustee (directed) Service code 25 | — | $10K |
| ROBERT IZO EIN 20-2366635 RETIREE | Trustee (directed) Service code 25 | — | $10K |
| STARKWEATHER & SHEPLEY CORP OF MA EIN 05-0222531 INSURANCE BROKER | Custodial (securities) Service code 19 | — | $8K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 145 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 145 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | TRANSAMERICA INSURANCE CO. | 121 | $227K |
| Prescription drug | EXPRESS SCRIPTS, INC. | 116 | $106K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 121 | — |
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.