| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UNKNOWN3 | UNKNOWN DEERFIELD, MA 01342 | HEALTH NEW ENGLAND, INC. | $59K | — | $59K | 2.93% |
| SMITH BROTHERS INSURANCE LLC3 Filed as: SMITH BROTHERS INSURANCE, INC. | 68 NATIONAL DRIVE GLASTONBURY, CT 06033 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $9K | — | $9K | 0.69% |
| SMITH BROTHERS INSURANCE LLC3 Filed as: SMITH BROTHERS INSURANCE, INC. | 68 NATIONAL DRIVE GLASTONBURY, CT 06033 | DENTAL SERVICE OF MASSACHUSETTS, INC. | $5K | — | $5K | 3.55% |
| SMITH BROTHERS INSURANCE LLC3 Filed as: SMITH BROTHERS INSURANCE, INC. | 68 NATIONAL DRIVE GLASTONBURY, CT 06033 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 15.00% |
| SMITH BROTHERS INSURANCE LLC3 Filed as: SMITH BROTHERS INSURANCE, INC. | 68 NATIONAL DRIVE GLASTONBURY, CT 06033 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | — | $6K | 11.39% |
| SMITH BROTHERS INSURANCE LLC3 Filed as: SMITH BROTHERS INSURANCE, INC. | 68 NATIONAL DRIVE GLASTONBURY, CT 06033 | EYEMED VISION CARE | $920 | — | $920 | 8.32% |
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 | 346 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 11 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 357 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTH NEW ENGLAND, INC. | 731 | $3.2M |
| Dental(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 731 | $1.4M |
| Vision | EYEMED VISION CARE | 325 | $11K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 346 | $107K |
| Long-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 346 | $107K |
| Prescription drug(2 contracts, 2 carriers) | HEALTH NEW ENGLAND, INC. | 731 | $3.2M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 346 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 731 | — |
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.