| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SENTINEL INSURANCE AGENCY, INC.3 Filed as: SENTINEL INSURANCE AGENCY | 100 QUANNAPOWIT PARKWAY SUITE 300 WAKEFIELD, MA 01880 | FALLON HEALTH | $29K | — | $29K | 1.97% |
| FRED C. CHURCH INC.3 Filed as: FRED C. CHURCH | 41 WELLMAN STREET LOWELL, MA 01851 | FALLON HEALTH | $8K | — | $8K | 1.00% |
| SENTINEL INSURANCE AGENCY, INC.3 Filed as: SENTINEL INSURANCE AGENCY | 100 QUANNAPOWIT PARKWAY SUITE 300 WAKEFIELD, MA 01880 | FALLON HEALTH & LIFE ASSURANCE COMPANY | $1K | — | $1K | 2.20% |
| FRED C. CHURCH INC.3 Filed as: FRED C. CHURCH | 41 WELLMAN STREET LOWELL, MA 01851 | FALLON HEALTH & LIFE ASSURANCE COMPANY | $420 | — | $420 | 1.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ULTRABENEFITS, INC. EIN 04-3525752 SERVICE PROVIDER | Contract Administrator; Claims processing Service code 12 | — | $8K |
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 | 116 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 53 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 169 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 2 carriers) | FALLON HEALTH | 293 | $2.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 293 | — |
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."
No prospect flags tripped on this filing.