| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EASTERN BENEFITS GROUP3 | 233 WEST CENTRAL STREET NATICK, MA 01760 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $50K | $8K | $58K | 2.68% |
| EASTERN BENEFITS GROUP3 | 233 WEST CENTRAL STREET NATICK, MA 01760 | AMERICAN FIDELITY ASSURANCE COMPANY | $4K | $0 | $4K | 2.09% |
| NEW ENGLAND EMPLOYEE BENEFITS CO3 Filed as: NEW ENGLAND AUTO DEALERS | UNKNOWN EAST BRIDGEWATER, MA 02333 | AMERICAN FIDELITY ASSURANCE COMPANY | $0 | $619 | $619 | 0.36% |
| MSADA3 | UNKOWN BOSTON, MA 02109 | AMERICAN FIDELITY ASSURANCE COMPANY | $0 | $233 | $233 | 0.13% |
| AMERICAN FIDELITY GENERAL AGENCY3 | 9000 CAMERON PARKWAY OKLAHOMA CITY, OK 73114 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $927 | $0 | $927 | 20.99% |
| KARIN L. PETERSEN3 | 337 LYNWOOD DRIVE SEVERNA PARK, MD 21146 | AFLAC | $9 | $0 | $9 | 3.50% |
| ADRIANA E. ANDERSON3 | 80 JACQUES ROAD TYNGSBORO, MA 01879 | AFLAC | $5 | $0 | $5 | 1.95% |
| KAREN TUCCI3 | 73 STETSON DRIVE MARLBOROUGH, MA 01752 | AFLAC | $4 | $0 | $4 | 1.56% |
| DANIEL P CLARK3 Filed as: DANIEL P. CLARK | 33 LANDAU ROAD PLAINVILLE, MA 02762 | AFLAC | $1 | $0 | $1 | 0.39% |
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 | 134 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 238 | $2.2M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 238 | $2.2M |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 68 | $4K |
| Short-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 89 | $174K |
| Long-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 89 | $174K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 238 | $2.2M |
| Other(2 contracts, 2 carriers) | AMERICAN FIDELITY ASSURANCE COMPANY | 89 | $174K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 238 | — |
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.