| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | HARVARD PILGRIM HEALTH CARE | $23K | — | $23K | 1.80% |
| HRK BROKERAGE SERVICES LLC3 Filed as: HRK BROKERAGE SERVICES, LLC | 905B S. MAIN STREET MANSFIELD, MA 02048 | HARVARD PILGRIM HEALTH CARE | $9K | — | $9K | 0.72% |
| KRISTEN M ALLISON3 Filed as: KRISTEN M. ALLISON | 2211 MICHELSON DRIVE IRVINE, CA 92612 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 10.67% |
| KENNETH S BETTENHAUSER3 Filed as: KENNETH S. BETTENHAUSER | 890 WINTER STREET, SUITE 208 WALTHAM, MA 02451 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $393 | — | $393 | 0.81% |
| KRISTEN M ALLISON3 Filed as: KRISTEN M. ALLISON | 2211 MICHELSON DRIVE IRVVINE, CA 92612 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 14.49% |
| KENNETH S BETTENHAUSER3 Filed as: KENNETH S. BETTENHAUSER | 890 WINTER STREET, SUITE 208 WALTHAM, MA 02451 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $165 | — | $165 | 1.39% |
| KRISTEN M ALLISON3 Filed as: KRISTEN M. ALLISON | 226 MORNING CANYON ROAD CORONA DEL MAR, CA 92625 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 31.01% |
| KENNETH S BETTENHAUSER3 Filed as: KENNETH S. BETTENHAUSER | 107 PRATTS MILL ROAD SUDBURY, MA 01776 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $281 | — | $281 | 3.10% |
| R FINE & R FINE INS LLC3 Filed as: R FINE AND R FINE INSURANCE LLC | 1101 WORCESTER ROAD FRAMINGHAM, MA 01701 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5 | — | $5 | 0.06% |
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 | 96 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 8 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HARVARD PILGRIM HEALTH CARE | 205 | $1.3M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 75 | $9K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 95 | $60K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 95 | $49K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 95 | $49K |
| Prescription drug | HARVARD PILGRIM HEALTH CARE | 205 | $1.3M |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 95 | $60K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 205 | — |
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.