| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RSC INSURANCE BROKERAGE INC3 | 160 FEDERAL STREET FL2 BOSTON, MA 021101700 | METROPOLITAN LIFE INSURANCE COMPANY | $60K | $34K | $94K | 1.96% |
| MICHAEL P TSOTSIS3 Filed as: MICHAEL P. TSOTSIS | 446 MAIN STREET, STE 19 WORCESTER, MA 016082368 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $5K | $11K | 0.22% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON PENNSYLVANIA | 1500 MARKET ST. #22E PHILADELPHIA, PA 19102 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | $5K | $0 | $5K | 0.80% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| T. ROWE PRICE ASSOCIATES, INC. EIN 52-0556948 NONE | Investment management Service code 28 | — | $138K |
| TOWERS WATSON PENNSYLVANIA EIN 23-1159360 NONE | Investment management Service code 28 | — | $136K |
| BANK OF NEW YORK MELLON EIN 13-5160382 NONE | Custodial (securities); Custodial (other than securities) Service code 18 | — | $44K |
| CLIFTONLARSONALLEN LLP EIN 41-0746749 NONE | Accounting (including auditing) Service code 10 | — | $25K |
| AON HEWITT EIN 36-2235791 NONE | Actuarial Service code 11 | — | $15K |
| XEROX CORPORATION EIN 16-0468020 NONE | Account maintenance fees Service code 65 | — | $13K |
| SSGA S&P 500 INDEX NON-LENDING EIN 04-6625099 NONE | Investment management Service code 28 | — | $8K |
| AON HEWITT INVESTMENT CONSULTING EIN 36-3109431 NONE | Consulting (general) Service code 16 | — | $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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2,328 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,328 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | 228 | $1.9M |
| Dental(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | 228 | $987K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 2,984 | $4.8M |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 2,984 | $4.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,984 | — |
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.