| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NE | 299 BALLARDVALE STREET WILMINGTON, MA 01887 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $117K | $56K | $173K | 3.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NE | 299 BALLARDVALE STREET WILMINGTON, MA 01887 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $7K | — | $7K | 2.00% |
| INDIGO INSURANCE SERVICES3 | 401 PARK DRIVE BOSTON, MA 02215 | USABLE LIFE | $29K | — | $29K | 25.00% |
| INDIGO INSURANCE SERVICES3 | 401 PARK DRIVE BOSTON, MA 02215 | USABLE LIFE | $28K | — | $28K | 25.00% |
| INDIGO INSURANCE SERVICES3 | 401 PARK DRIVE BOSTON, MA 02215 | USABLE LIFE | $17K | — | $17K | 25.00% |
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 | 680 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 680 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 489 | $5.7M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 391 | $357K |
| Life insurance | USABLE LIFE | 680 | $66K |
| Long-term disability | USABLE LIFE | 606 | $113K |
| Other(2 contracts) | USABLE LIFE | 680 | $182K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 680 | — |
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.