| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE AGENCY, INC. | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | $57K | $0 | $57K | 2.77% |
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE AGENCY, INC. | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | $5K | $0 | $5K | 5.12% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 03302 | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | $1K | $0 | $1K | 1.21% |
| THE RICHARDS GROUP3 Filed as: RICHARDS INC | PO BOX 820 BRATTLEBORO, VT 05302 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $656 | $0 | $656 | 1.25% |
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE AGENCY, INC. | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $112 | $112 | 0.21% |
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE AGENCY, INC. | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | BOSTON MUTUAL LIFE INSURANCE COMPANY | $6K | $0 | $6K | 13.66% |
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE AGENCY, INC. | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | RED TREE INSURANCE COMPANY, INC. | $808 | $0 | $808 | 10.16% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 03302 | RED TREE INSURANCE COMPANY, INC. | $121 | $0 | $121 | 1.52% |
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 | 251 | 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) | 254 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | 290 | $2.0M |
| Dental | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | 220 | $102K |
| Vision | RED TREE INSURANCE COMPANY, INC. | 134 | $8K |
| Life insurance(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 234 | $94K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 171 | $52K |
| Long-term disability | BOSTON MUTUAL LIFE INSURANCE COMPANY | 234 | $42K |
| Prescription drug | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | 290 | $2.0M |
| Other(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 234 | $94K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 290 | — |
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.