| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INDIGO INSURANCE SVC3 Filed as: INDIGO INSURANCE SVCS | 5TH FLOOR WORCESTER, MA 01608 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $5K | $9K | $14K | 6.36% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD EIN 04-1045815 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $802K |
| DELTA DENTAL EIN 04-6143185 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $109K |
| HANNON, L. EIN 04-2145367 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $79K |
| WILLIS EIN 04-2792279 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $65K |
| MODERN ASSISTANCE PROGRAMS INC EIN 04-3014253 NONE | Other services; Direct payment from the plan Service code 49 | — | $60K |
| FEINBERG, CAMPBELL & ZACK EIN 04-2738936 NONE | Legal; Direct payment from the plan Service code 29 | — | $58K |
| BARKER, S. EIN 04-2145367 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $55K |
| ERNA, P. EIN 04-2145367 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $53K |
| INNOVATIVE SOFTWARE SOLUTIONS EIN 23-2182079 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $46K |
| RASO, C. EIN 04-2145367 EXECUTIVE DIRECTOR | Direct payment from the plan; Plan Administrator Service code 14 | — | $42K |
| SARNO, G. EIN 04-2145367 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $41K |
| GAITA, R. EIN 04-2145367 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $40K |
| MANZI & ASSOCIATES, LLC EIN 04-3508036 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $36K |
| HARVEY, K. EIN 04-2145367 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $30K |
| VALLETTA, A. EIN 04-2145367 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $24K |
| SMITH, J. EIN 04-2145367 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $24K |
| SEGAL ADVISORS INC. EIN 13-1835864 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $23K |
| DAMIGELLA, C. EIN 04-2145367 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $18K |
| STATE STREET GLOBAL ADVISORS EIN 04-1867445 NONE | Custodial (securities); Soft dollars commissions; Investment management fees paid directly by plan; Custodial (other than securities) Service code 18 | — | $16K |
| BEAUDRY, W. EIN 04-2145367 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $14K |
| AJV COMPUTER SERVICES NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 2 ANNE ROAD GREENVILLE, RI 02828 | $12K |
| DAVIS VISION EIN 11-3051991 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $9K |
| PETRILLO, P. EIN 04-2145367 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $7K |
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 | 1,625 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 184 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 8 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,817 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AMERICAN GENERAL LIFE INSURANCE COMPANY | 1,955 | $220K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MA | 1,743 | $397K |
| Other | AMERICAN GENERAL LIFE INSURANCE COMPANY | 1,955 | $220K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,955 | — |
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.