| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ENROLLEASE3 Filed as: STRATEGIC BENEFIT ADVISORS INC | 144 TURNPIKE ROAD, SUITE 330 SOUTHBOROUGH, MA 01772 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $22K | — | $22K | 5.04% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WILLIAM GALLAGHER ASSOCIATES | 470 ATLANTIC AVE BOSTON, MA 02210 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $15K | — | $15K | 3.59% |
| ENROLLEASE3 Filed as: STRATEGIC BENEFIT ADVISORS INC | 144 TURNPIKE ROAD, SUITE 330 SOUTHBOROUGH, MA 01772 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $10K | — | $10K | 2.91% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WILLIAM GALLAGHER ASSOCIATES | 470 ATLANTIC AVE BOSTON, MA 02210 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $7K | — | $7K | 2.05% |
| ENROLLEASE3 Filed as: STRATEGIC BENEFIT ADVISORS INC | 144 TURNPIKE ROAD, SUITE 330 SOUTHBOROUGH, MA 01772 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $9K | $0 | $9K | 2.91% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WILLIAM GALLAGHER ASSOCIATES | 470 ATLANTIC AVE BOSTON, MA 02210 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $6K | $0 | $6K | 2.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS AND BLUE SHIELD OF VERMO EIN 03-0277307 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator; Insurance services Service code 12 | — | $768K |
| DELTA DENTAL PLAN OF VERMONT, INC. EIN 03-0219391 DENTAL CLAIMS PROCESSING | Claims processing Service code 12 | — | $73K |
| EBPA LLC EIN 20-1879465 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $45K |
| LIBERTY MUTUAL INSURANCE EIN 04-6076039 STD ADMIN SERVICES | Insurance services; Contract Administrator; Claims processing Service code 12 | — | $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 | 1,018 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 47 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,065 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 900 | $134K |
| Life insurance | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,345 | $432K |
| Short-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 944 | $331K |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,343 | $292K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 1,020 | $808K |
| Other | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,345 | $432K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,345 | — |
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.