| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLARK INSURANCE3 Filed as: CLARK & LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DR MERRIMACK, NH 03054 | NATIONWIDE LIFE INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
| CLARK INSURANCE3 Filed as: CLARK & LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DR MERRIMACK, NH 03054 | BLUE CROSS BLUE SHIELD OF MA | $5K | $0 | $5K | 4.24% |
| CLARK INSURANCE3 Filed as: CLARK & LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DR MERRIMACK, NH 03054 | DEARBORN NATIONAL LIFE COMPANY | $9K | $0 | $9K | 12.90% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | DEARBORN NATIONAL LIFE COMPANY | — | $3K | $3K | 4.31% |
| CLARK INSURANCE3 Filed as: CLARK & LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DR MERRIMACK, NH 03054 | VSP VISION SERVICE PLAN | $845 | $0 | $845 | 6.68% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTH PLANS, INC EIN 04-2734278 THIRD PARTY ADMINISTRATOR | Other services; Claims processing Service code 12 | — | $86K |
| CLARK & LAVEY BENEFITS SOLUTIONS EIN 04-3348257 BROKER/CONSULTANT | Insurance agents and brokers Service code 22 | — | $52K |
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 | 143 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 143 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUE CROSS BLUE SHIELD OF MA | 329 | $109K |
| Vision | VSP VISION SERVICE PLAN | 115 | $13K |
| Life insurance | DEARBORN NATIONAL LIFE COMPANY | 170 | $74K |
| Short-term disability | DEARBORN NATIONAL LIFE COMPANY | 170 | $74K |
| Long-term disability | DEARBORN NATIONAL LIFE COMPANY | 170 | $74K |
| Stop-loss / reinsurancereinsurance | NATIONWIDE LIFE INSURANCE COMPANY | 143 | $443K |
| Other | DEARBORN NATIONAL LIFE COMPANY | 170 | $74K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 329 | — |
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.