| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE HEALTH SOLUTIONS INC | 184 WORCESTER PROVIDENCE TNPK SUTTON, MA 01590 | HARTFORD LIFE & ACCIDENT INSURANCE COMPANY | $19K | — | $19K | 9.35% |
| SMALL BUSINESS INSURANCE AGENCY3 Filed as: SMALL BUSINESS INS AGCY IN | 542 MAIN STREET WORCESTER, MA 01608 | HARTFORD LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 9.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD EIN 04-1045815 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $875K |
| R. REED EIN 04-2219623 PLAN EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $153K |
| FALLON HEALTH AND LIFE INSURANCE CO EIN 04-3169246 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $99K |
| MANZI & ASSOCIATES LLC EIN 04-3508036 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $70K |
| CONGRESS WEALTH MANAGEMENT EIN 04-2848965 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $69K |
| L. O'KEEFE EIN 04-2219623 PLAN EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $60K |
| N. GODIN EIN 04-2219623 PLAN EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $54K |
| C. SCHIAVONE EIN 04-2219623 PLAN EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $50K |
| D. ROBERGE EIN 04-2219623 PLAN EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $50K |
| MEKETA INVESTMENT GROUP EIN 04-2659023 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $39K |
| INNOVATIVE SOFTWARE SOLUTIONS, INC EIN 23-2182079 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $36K |
| SUNSET LANDSCAPING NONE | Direct payment from the plan; Other services Service code 49 | 173 HENSHAW ST LEICESTER, MA 01524 | $34K |
| CLEARVIEW CLEANING INC NONE | Other services; Direct payment from the plan Service code 49 | PO BOX 523 HOLDEN, MA 01520 | $26K |
| A. FRIEDMAN EIN 04-2219623 PLAN EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $26K |
| TPG HEALTHCARE CONSULTING EIN 20-8069824 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $26K |
| BOSTON BENEFIT PARTNERS EIN 04-3422351 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $18K |
| RON TAYLOR NONE | Other services; Direct payment from the plan Service code 49 | 8 CHAMBERLAIN PARKWAY WORCESTER, MA 01602 | $15K |
| V. WILLIAMSON EIN 04-2219623 PLAN EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $14K |
| PETER J. RIEMER LLC EIN 83-0366061 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $11K |
| C. MANIERO EIN 04-2219623 PLAN EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $9K |
| DAVIS VISION EIN 11-3051991 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $8K |
| INTERCONTINENTAL REAL ESTATE EIN 04-3613055 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $6K |
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 | 1,374 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 97 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,471 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE & ACCIDENT INSURANCE COMPANY | 1,433 | $207K |
| Stop-loss / reinsurancereinsurance | ACE AMERICAN INSURANCE COMPANY | 1,471 | $211K |
| Other | HARTFORD LIFE & ACCIDENT INSURANCE COMPANY | 1,471 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,471 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.