| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: JENNIFER A. BORISLOW AGENCY INC | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | $24K | $7K | $31K | 2.15% |
| ASSUREDPARTNERS3 Filed as: JENNIFER A. BORISLOW AGENCY INC | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | HPHC INSURANCE COMPANY | $19K | $6K | $24K | 2.16% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS | 1787 SENTRY PARKWAY W VEVA 16, SUITE 320 BLUE BELL, PA 19422 | LINCOLN LIFE NATIONAL LIFE INSURANCE COMPANY | $0 | $7K | $7K | 5.00% |
| ASSUREDPARTNERS3 Filed as: JENNIFER A. BORISLOW AGENCY INC | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | LINCOLN LIFE NATIONAL LIFE INSURANCE COMPANY | $7K | $0 | $7K | 5.00% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS | 669 RIVER DRIVE CENTER LL, SUITE 305 ELMWOOD PARK, NJ 07407 | LINCOLN LIFE NATIONAL LIFE INSURANCE COMPANY | $0 | $6K | $6K | 4.32% |
| ASSUREDPARTNERS3 Filed as: JENNIFER A. BORISLOW AGENCY INC | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | DELTA DENTAL OF NEW HAMPSHIRE, INC | $6K | $0 | $6K | 4.98% |
| ASSUREDPARTNERS3 Filed as: JENNIFER A. BORISLOW AGENCY INC | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | RED TREE INSURANCE COMPANY, INC. | $307 | $0 | $307 | 9.16% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 03302 | RED TREE INSURANCE COMPANY, INC. | $46 | $0 | $46 | 1.37% |
| ASSUREDPARTNERS3 Filed as: JENNIFER A. BORISLOW AGENCY INC | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | RED TREE INSURANCE COMPANY, INC. | $189 | $0 | $189 | 9.22% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 03302 | RED TREE INSURANCE COMPANY, INC. | $28 | — | $28 | 1.37% |
| CHUBB INSURANCE SOLUTIONS AGENCY3 Filed as: CHUBB INSURANCE SOLUTIONS | 202 HALLS MILLS ROAD WHITEHOUSE STATION, NJ 08889 | FEDERAL INSURANCE COMPANY | $257 | — | $257 | 18.04% |
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 | 128 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 31 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 159 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | 128 | $2.6M |
| Dental | DELTA DENTAL OF NEW HAMPSHIRE, INC | 249 | $116K |
| Vision(2 contracts) | RED TREE INSURANCE COMPANY, INC. | 76 | $5K |
| Life insurance | LINCOLN LIFE NATIONAL LIFE INSURANCE COMPANY | 216 | $136K |
| Short-term disability | LINCOLN LIFE NATIONAL LIFE INSURANCE COMPANY | 216 | $136K |
| Long-term disability | LINCOLN LIFE NATIONAL LIFE INSURANCE COMPANY | 216 | $136K |
| Prescription drug(2 contracts, 2 carriers) | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | 128 | $2.6M |
| Other(2 contracts, 2 carriers) | LINCOLN LIFE NATIONAL LIFE INSURANCE COMPANY | 216 | $137K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 249 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.