| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: JENNIFER A. BORISLOW INS AGENCY INC | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | BLUE CROSS BLUE SHIELD OF MA | $52K | $6K | $58K | 3.48% |
| ASSUREDPARTNERS3 Filed as: JENNIFER A. BORISLOW INS AGENCY INC | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | HARTFORD LIFE AND ACCIDENT | $5K | $0 | $5K | 11.07% |
| INDIGO INSURANCE SERVICES3 Filed as: INDIGO INSURANCE SERVICES, LLC | 100 FRONT STREET, 20TH FLOOR WORCESTER, MA 01608 | HARTFORD LIFE AND ACCIDENT | $0 | $3K | $3K | 7.00% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN INSURANCE SVCS., INC. | 100 RIALTO PLACE, SUITE 900 MELBOURNE, FL 32901 | HARTFORD LIFE AND ACCIDENT | $0 | $2 | $2 | 0.00% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN INSURANCE SVCS., INC. | 901 MARQUETTE AVENUE, SUITE 1800 MINNEAPOLIS, MN 55402 | HARTFORD LIFE AND ACCIDENT | -$1 | $0 | -$1 | -0.00% |
| ASSUREDPARTNERS3 Filed as: JENNIFER A. BORISLOW INS AGENCY INC | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | VISION SERVICE PLAN | $188 | $0 | $188 | 9.99% |
| GIS NATIONAL3 | 9500 KOGER AVENUE, SUITE 200 ST PETERSBURG, FL 33702 | METLIFE | $287 | — | $287 | 18.33% |
| ASSUREDPARTNERS3 Filed as: JENNIFER A. BORISLOW INS AGENCY INC | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | METLIFE | $157 | $0 | $157 | 10.03% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON CHAPMAN BENEFIT ADMINSTRS. | PO BOX 9201 AUSTIN, TX 78766 | METLIFE | $0 | $78 | $78 | 4.98% |
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 | 122 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 122 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MA | 163 | $1.7M |
| Dental | BLUE CROSS BLUE SHIELD OF MA | 163 | $1.7M |
| Vision | VISION SERVICE PLAN | 13 | $2K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 122 | $48K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 122 | $48K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MA | 163 | $1.7M |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 122 | $49K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 163 | — |
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.