| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UNKNOWN3 | UNKNOWN SPRINGFIELD, MA 01101 | HEALTH NEW ENGLAND, INC. | $45K | $0 | $45K | 3.97% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | STANDARD INSURANCE COMPANY | $2K | $0 | $2K | 3.01% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | STANDARD INSURANCE COMPANY | $0 | $796 | $796 | 1.18% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $2K | $8K | 14.62% |
| USI INSURANCE SERVICES LLC3 | UNKNOWN CHICOPEE, MA 01020 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 7.87% |
| RICHARD HASKINS3 | PO BOX 362 MILLBURG, MA 01527 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $238 | $30 | $268 | 1.52% |
| STEPHEN QUITADAMO3 | 3 KELLY STREET AUBURN, MA 01501 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $113 | $0 | $113 | 0.64% |
| LISA M AMBRUSON3 Filed as: LISA M. AMBRUSON | PO BOX 1222 WARREN, MA 01083 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $53 | $0 | $53 | 0.30% |
| J KING INSURANCE INC3 Filed as: J KING INSURANCE INC & OTHER AGENTS | 50 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $30 | $23 | $53 | 0.30% |
| THERESA CATHERINE MACMILLAN3 | 650 EAST GREENWICH AVENUE WEST WARWICK, RI 02893 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $41 | $1 | $42 | 0.24% |
| EDWARD H SPATER3 Filed as: EDWARD H. SPATER | PO BOX 351 EAST BROOKFIELD, MA 01515 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $12 | $0 | $12 | 0.07% |
| USI INSURANCE SERVICES LLC3 | 2377 BOSTON POST ROAD WILBRAHAM, MA 01095 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $869 | $0 | $869 | 10.35% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $794 | $0 | $794 | 9.45% |
| USI INSURANCE SERVICES LLC3 | UNKOWN SPRINGFIELD, MA 01101 | EMPLOYEE SERVICES, INC. | $202 | $0 | $202 | 5.00% |
| USI INSURANCE SERVICES LLC3 | 711 EAST MAIN STREET, SUITE 201 CHICOPEE, MA 01020 | NATIONAL UNION FIRE INSURANCE CO. OF PITTSBURGH, PA | $405 | $0 | $405 | 15.00% |
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 | 114 | 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) | 114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH NEW ENGLAND, INC. | 80 | $1.1M |
| Dental | STANDARD INSURANCE COMPANY | 86 | $68K |
| Vision(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 130 | $76K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 99 | $54K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 99 | $54K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 99 | $54K |
| Prescription drug | HEALTH NEW ENGLAND, INC. | 80 | $1.1M |
| Other(4 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 114 | $79K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 130 | — |
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.