| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SAPERS & WALLACK3 | 275 WASHINGTON STREET SUITE 110 NEWTON, MA 02458 | AETNA LIFE INSURANCE COMPANY | $42K | — | $42K | 3.18% |
| PARTNERS BENEFIT GROUP LLC3 Filed as: PARTNERS BENEFIT GROUP INC. | PO BOX 869 NORWELL, MA 02061 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $636 | $3K | 8.08% |
| SAPERS & WALLACK3 | 275 WASHINGTON STREET SUITE 110 NEWTON, MA 02458 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 13.95% |
| SAPERS & WALLACK3 | 275 WASHINGTON STREET SUITE 110 NEWTON, MA 02458 | VISION SERVICE PLAN | $851 | — | $851 | 6.63% |
| PARTNERS BENEFIT GROUP LLC3 Filed as: PARTNERS BENEFIT GROUP INC. | PO BOX 869 NORWELL, MA 02061 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $181 | $2K | 16.75% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| REIMBURSEMENT SPECIALISTS, INC. EIN 46-1120738 DENTAL CLAIMS ADMIN. | Claims processing; Contract Administrator Service code 12 | — | $21K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 HRA ADMINISTRATION | Claims processing; Contract Administrator Service code 12 | — | $7K |
| SENTINEL BENEFITS & FINANCIAL GROUP FSA ADMINISTRATION | Contract Administrator; Claims processing Service code 12 | 100 QUANNAPOWITT PARKWAY SUITE 300 WAKEFIELD, MA 01880 | $5K |
| MEMBERS INSURANCE AGENCY LLC INSURANCE BROKER | Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 845 DONALD LYNCH BLVD MARLBOROUGH, MA 01752 | $4K |
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 | 186 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 186 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 266 | $1.3M |
| Vision | VISION SERVICE PLAN | 99 | $13K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 186 | $51K |
| Long-term disability | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | 186 | $19K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 186 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 266 | — |
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.