| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NEW ENGLAND LLC | 299 BALLARDVALE STREET WILMINGTON, MA 01887 | HARVARD PILGRIM HEALTH CARE | $30K | $0 | $30K | 1.66% |
| M FINANCIAL HOLDINGS INC3 Filed as: FM FINANCIAL SERVICES, INC. | 141 W GREEN STREET PASADENA, CA 91105 | HARVARD PILGRIM HEALTH CARE | $9K | $0 | $9K | 0.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NEW ENGLAND LLC | 299 BALLARDVALE STREET WILMINGTON, MA 01887 | HARVARD PILGRIM HEALTH CARE | $11K | $0 | $11K | 1.65% |
| M FINANCIAL HOLDINGS INC3 Filed as: FM FINANCIAL SERVICES, INC. | 141 W GREEN STREET PASADENA, CA 91105 | HARVARD PILGRIM HEALTH CARE | $3K | $0 | $3K | 0.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NEW ENGLAND LLC | 299 BALLARDVALE STREET WILMINGTON, MA 01887 | HARVARD PILGRIM HEALTH CARE | $3K | $0 | $3K | 1.65% |
| M FINANCIAL HOLDINGS INC3 Filed as: FM FINANCIAL SERVICES, INC. | 141 W GREEN STREET PASADENA, CA 91105 | HARVARD PILGRIM HEALTH CARE | $1K | $0 | $1K | 0.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NEW ENGLAND LLC | 299 BALLARDVALE STREET WILMINGTON, MA 01887 | EYEMED VISION CARE | $2K | $0 | $2K | 10.88% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NEW ENGLAND LLC | 299 BALLARDVALE STREET WILMINGTON, MA 01887 | HARVARD PILGRIM HEALTH CARE | $179 | $0 | $179 | 1.29% |
| M FINANCIAL HOLDINGS INC3 Filed as: FM FINANCIAL SERVICES, INC. | 141 W GREEN STREET PASADENA, CA 91105 | HARVARD PILGRIM HEALTH CARE | $54 | $0 | $54 | 0.39% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NEW ENGLAND LLC | 299 BALLARDVALE STREET WILMINGTON, MA 01887 | HARVARD PILGRIM HEALTH CARE | $108 | $0 | $108 | 1.65% |
| M FINANCIAL HOLDINGS INC3 Filed as: FM FINANCIAL SERVICES, INC. | 141 W. GREEN STREET PASADENA, CA 91105 | HARVARD PILGRIM HEALTH CARE | $33 | $0 | $33 | 0.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NEW ENGLAND LLC | 299 BALLARDVALE STREET WILMINGTON, MA 01887 | HARVARD PILGRIM HEALTH CARE | $72 | $0 | $72 | 1.65% |
| M FINANCIAL HOLDINGS INC3 Filed as: FM FINANCIAL SERVICES, INC. | 141 W GREEN STREET PASADENA, CA 91105 | HARVARD PILGRIM HEALTH CARE | $22 | $0 | $22 | 0.51% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL PLAN OF NEW HAMPSHIRE EIN 02-0273013 DENTAL CLAIMS PROCESSING | Claims processing Service code 12 | ONE DELTA DRIVE CONCORD, NH 03302 | $22K |
| HUB INTERNATIONAL NEW ENGLAND LLC EIN 04-2623673 BROKER | Insurance agents and brokers Service code 22 | — | $5K |
| COMBINED SERVICES LLC EIN 02-0479434 BROKER | Insurance agents and brokers Service code 22 | — | $2K |
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 | 259 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 259 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(6 contracts) | HARVARD PILGRIM HEALTH CARE | 314 | $2.7M |
| Vision | EYEMED VISION CARE | 301 | $19K |
| Other(3 contracts) | HARVARD PILGRIM HEALTH CARE | 120 | $669K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 314 | — |
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.