| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET LOWELL, MA 01851 | HARVARD PILGRIM HEALTH CARE | $53K | — | $53K | 2.76% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET LOWELL, MA 01851 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $767 | $10K | 9.31% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET LOWELL, MA 01851 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $126 | $3K | 16.05% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET LOWELL, MA 01851 | HARVARD PILGRIM HEALTH CARE | $378 | — | $378 | 2.76% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DENTAL SERVICE OF MASSACHUSETTS INC EIN 04-6143185 THIRD PARTY ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | 465 MEDFORD STREET BOSTON, MA 02129 | $20K |
| HRC TOTAL SOLUTIONS EIN 30-0041952 THIRD PARTY ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | 111 CHARLES STREET MANCHESTER, NH 03101 | $7K |
| FRED C. CHURCH INC. EIN 04-2445292 BROKER | Insurance agents and brokers Service code 22 | 41 WELLMAN STREET LOWELL, MA 01851 | $5K |
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 | 225 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 225 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | HARVARD PILGRIM HEALTH CARE | 337 | $1.9M |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 225 | $102K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 225 | $102K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 225 | $102K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 225 | $119K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 337 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.