| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | HARVARD PILGRIM HEALTH CARE | $18K | — | $18K | 1.54% |
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE | ONE GRIFFIN BROOK DRIVE METHEUN, MA 01844 | HPHC INSURANCE COMPANY | $5K | — | $5K | 1.54% |
| THE PROTECTOR GROUP INS. AGENCY3 Filed as: THE PROTECTOR GROUP INS. AGCY., INC | 100 FRONT STREET, 8TH FLOOR WORCESTER, MA 01608 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | — | $6K | 8.56% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY, LLC | 500 BOYLSTON STREET, SUITE 300 BOSTON, MA 02116 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $1K | $1K | 1.94% |
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $976 | — | $976 | 10.00% |
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 | 172 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 173 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HARVARD PILGRIM HEALTH CARE | 219 | $1.4M |
| Vision | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 107 | $10K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 172 | $72K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 172 | $72K |
| Prescription drug(2 contracts, 2 carriers) | HARVARD PILGRIM HEALTH CARE | 219 | $1.4M |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 172 | $72K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 219 | — |
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.