| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET CONNECTOR PARK LOWELL, MA 01851 | EYEMED VISION CARE | $5K | — | $5K | 9.30% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET CONNECTOR PARK LOWELL, MA 01851 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $300 | $4K | 9.40% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET CONNECTOR PARK LOWELL, MA 01851 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $230 | $5K | 15.75% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET CONNECTOR PARK LOWELL, MA 01851 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $948 | $69 | $1K | 11.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE BENEFIT ADMINISTRATORS OF MASS EIN 27-1502067 THIRD PARTY ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | PO BOX 55917 BOSTON, MA 02205 | $155K |
| FRED C. CHURCH INC. EIN 04-2445292 BROKER | Insurance agents and brokers Service code 22 | 41 WELLMAN STREET LOWELL, MA 01851 | $79K |
| THE GUARDIAN LIFE INSURANCE COMPANY EIN 13-5123390 THIRD PARTY ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | 7 HANOVER SQUARE NEW YORK, NY 10004 | $27K |
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 | 561 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 561 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED VISION CARE | 577 | $56K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 561 | $9K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 561 | $0 |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 561 | $40K |
| Stop-loss / reinsurancereinsurance | BCBS OF MA | 343 | $424K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 561 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 577 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.