| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: JENNIFER A. BORISLOW IN. AGY., INC. | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $38K | $14K | $52K | 2.13% |
| ASSUREDPARTNERS3 Filed as: JENNIFER A. BORISLOW IN. AGY., INC. | ONE GRIFFIN BROOK DRIVE, 2ND FLOOR METHUEN, MA 01844 | DELTA DENTAL OF MASSACHUSETTS, INC. DBA DELTA DENTAL OF MA | $2K | $0 | $2K | 1.36% |
| ASSUREDPARTNERS3 Filed as: JENNIFER A. BORISLOW IN. AGY., INC. | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $3K | $11K | 13.31% |
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 | 156 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 158 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 250 | $2.5M |
| Dental | DELTA DENTAL OF MASSACHUSETTS, INC. DBA DELTA DENTAL OF MA | 262 | $142K |
| Vision | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 250 | $2.5M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 171 | $84K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 171 | $84K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 171 | $84K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 250 | $2.5M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 171 | $84K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 262 | — |
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.