| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INDIGO INSURANCE SERVICES3 Filed as: INDIGO INSURANCE SERVICES LLC | 446 MAIN ST 5TH FL WORCESTER, MA 01608 | SYMETRA LIFE INSURANCE COMPANY | $13K | — | $13K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD EIN 04-1045815 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $917K |
| PILLAR RX CONSULTING NONE | Direct payment from the plan; Consulting (general) Service code 16 | 10700 W RESEARCH DRIVE SUITE 3 WAUWATOSA, WI 53226 | $152K |
| DELTA DENTAL EIN 04-6143185 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $108K |
| HANNON, L. EIN 04-2145367 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $93K |
| RUBINSTEIN ACTUARIAL SERVICES, LLC EIN 04-2792279 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $77K |
| RASO, C. EIN 04-2145367 EXECUTIVE DIRECTOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $74K |
| MODERN ASSISTANCE PROGRAMS INC EIN 04-3014253 NONE | Direct payment from the plan; Other services Service code 49 | — | $60K |
| INNOVATIVE SOFTWARE SOLUTIONS EIN 23-2182079 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $60K |
| HARVEY, T. EIN 04-2145367 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $59K |
| AMALGAMATED BANK EIN 13-4920330 NONE | Direct payment from the plan; Custodial (securities) Service code 19 | — | $55K |
| GAITA, R. EIN 04-2145367 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $48K |
| FEINBERG, DUMONT & BRENNAN EIN 04-2738936 NONE | Legal; Direct payment from the plan Service code 29 | — | $42K |
| MANZI & ASSOCIATES, LLC EIN 04-3508036 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $40K |
| HARVEY, K. EIN 04-2145367 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $37K |
| VALLETTA, A. EIN 04-2145367 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $35K |
| ERNA, P. EIN 04-2145367 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $30K |
| SMITH, J. EIN 04-2145367 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $28K |
| SEGAL MARCO ADVISORS INC. EIN 13-1835864 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $25K |
| DAMIGELLA, C. EIN 04-2145367 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $25K |
| BEAUDRY, W. EIN 04-2145367 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $18K |
| PETRILLO, P. EIN 04-2145367 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $17K |
| ROSE, M EIN 04-2145367 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $10K |
| DAVIS VISION EIN 11-3051991 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $9K |
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 | 1,593 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 285 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 6 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,884 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 2,006 | $256K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MA | 1,761 | $834K |
| Other | SYMETRA LIFE INSURANCE COMPANY | 2,006 | $256K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,006 | — |
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."
No prospect flags tripped on this filing.