| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENSERCO INC.3 | 140 SYLVAN AVENUE, SUITE 303 ENGLEWOOD CLIFFS, NJ 07632 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $32K | — | $32K | 1.95% |
| NATIONAL GROUP PROTECTION INC3 Filed as: NATIONAL GROUP PROTECTION | 1445 GREENBRIER PLACE CHARLOTTESVILLE, VA 22901 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $301 | — | $301 | 5.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENSERCO, INC. EIN 13-2732561 NONE | Contract Administrator Service code 13 | — | $27K |
| BUCHBINDER TUNICK & COMPANY LLP EIN 13-1578842 NONE | Accounting (including auditing) Service code 10 | — | $16K |
| MERRILL LYNCH EIN 13-5674085 NONE | Custodial (securities) Service code 19 | — | $16K |
| BLUE CROSS BLUE SHIELD OF MA EIN 04-1045815 NONE | Contract Administrator Service code 13 | — | $11K |
| LANGAN AND DEMPSEY EIN 04-2125930 NONE | Legal Service code 29 | — | $9K |
| THE SAVITZ ORGANIZATION EIN 23-1700844 NONE | Actuarial Service code 11 | — | $6K |
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 | 115 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 115 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 329 | $1.7M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 115 | $5K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 115 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 329 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.