| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: JENNIFER A BROISLOW INS AGENCY | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $42K | $9K | $51K | 1.79% |
| BROKER NOT PROVIDED3 Filed as: NO BROKER PROVIDED | NO ADDRESS PROVIDED NO ADDRESS PROVIDED, MA 99999 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $5K | $0 | $5K | 1.87% |
| ASSUREDPARTNERS3 Filed as: JENNIFER A BORISLOW INS AGENCY INC. | ONE GRIIFIN BROOK DR 2ND FLOOR METHUEN, MA 01844 | DENTAL SERVICE OF MASSACHUSETTS, INC. | $4K | $269 | $4K | 1.60% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 554 | $3.1M |
| Dental(2 contracts) | DENTAL SERVICE OF MASSACHUSETTS, INC. | 559 | $288K |
| Vision | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 554 | $2.8M |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 554 | $2.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 559 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.