| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RSC INSURANCE BROKERAGE INC3 | 160 FEDERAL ST FL 2 BOSTON, MA 02110 | HARVARD PILGRIM HEALTH CARE | $42K | — | $42K | 3.08% |
| MICHAEL P TSOTSIS3 Filed as: MICHAEL TSOTSIS | 446 MAIN STREET 19TH FLOOR WORCESTER, MA 01608 | HARVARD PILGRIM HEALTH CARE | $220 | — | $220 | 0.02% |
| RSC INSURANCE BROKERAGE INC3 | 1610 FEDERAL STREET FLOOR 2 BOSTON, MA 02110 | VISION SERVICE PLAN | $618 | — | $618 | 2.70% |
| RSC INSURANCE BROKERAGE INC3 | 1610 FEDERAL STREET FLOOR 2 BOSTON, MA 02110 | VISION SERVICE PLAN | $574 | — | $574 | 2.51% |
| RSC INSURANCE BROKERAGE INC3 | 160 FEDERAL STREET 2ND FLOOR BOSTON, MA 02110 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 12.00% |
| SULLIVAN GARRITY & DONNELLY INC3 Filed as: SULLIVAN GARRITY & DONNELLY | INSURANCE AGENCY INC 10 INSTITUTE ROAD WORCESTER, MA 01609 | SUN LIFE ASSURANCE COMPANY OF CANADA | $527 | — | $527 | 3.00% |
| RSC INSURANCE BROKERAGE INC3 | 160 FEDERAL STREET 2ND FLOOR BOSTON, MA 02110 | SUN LIFE ASSURANCE COMPANY OF CANADA | $789 | — | $789 | 11.99% |
| SULLIVAN GARRITY & DONNELLY INC3 Filed as: SULLIVAN GARRITY & DONNELLY INS AGY | 10 INSTITUTE ROAD WORCESTER, MA 01609 | SUN LIFE ASSURANCE COMPANY OF CANADA | $197 | — | $197 | 2.99% |
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 | 206 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 16 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 222 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HARVARD PILGRIM HEALTH CARE | 342 | $1.4M |
| Vision | VISION SERVICE PLAN | 142 | $23K |
| Life insurance(2 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 144 | $24K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 141 | $18K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 141 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 342 | — |
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.