| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLARK INSURANCE3 Filed as: CLARK & LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DRIVE MERRIMACK, NH 03054 | NATIONWIDE LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| CLARK INSURANCE3 Filed as: CLARK & LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DRIVE MERRIMACK, NH 03054 | BLUE CROSS BLUE SHIELD OF MA | $5K | $3K | $8K | 6.43% |
| CLARK INSURANCE3 Filed as: CLARK & LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DRIVE MERRIMACK, NH 03054 | MONY LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 7.47% |
| INDIGO INSURANCE SVC3 | 446 MAIN ST WORCESTER, MA 01608 | MONY LIFE INSURANCE COMPANY OF AMERICA | $0 | $3K | $3K | 4.91% |
| CLARK INSURANCE3 Filed as: CLARK & LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DRIVE MERRIMACK, NH 03054 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $5K | $0 | $5K | 13.72% |
| INDIGO INSURANCE SVC3 | 446 MAIN ST WORCESTER, MA 01608 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 7.00% |
| CLARK INSURANCE3 Filed as: CLARK & LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DRIVE MERRIMACK, NH 03054 | VSP VISION SERVICE PLAN | $908 | $0 | $908 | 6.29% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTH PLANS, INC EIN 04-2734278 THIRD PARTY ADMINISTRATOR | Other services; Claims processing Service code 12 | — | $98K |
| CLARK & LAVEY BENEFITS SOLUTIONS EIN 04-3348257 BROKER/CONSULTANT | Insurance agents and brokers Service code 22 | — | $58K |
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 | 144 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 144 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUE CROSS BLUE SHIELD OF MA | 326 | $130K |
| Vision | VSP VISION SERVICE PLAN | 120 | $14K |
| Life insurance(2 contracts, 2 carriers) | MONY LIFE INSURANCE COMPANY OF AMERICA | 175 | $105K |
| Short-term disability(2 contracts, 2 carriers) | MONY LIFE INSURANCE COMPANY OF AMERICA | 175 | $105K |
| Long-term disability(2 contracts, 2 carriers) | MONY LIFE INSURANCE COMPANY OF AMERICA | 175 | $105K |
| Stop-loss / reinsurancereinsurance | NATIONWIDE LIFE INSURANCE COMPANY | 144 | $593K |
| Other | AMERICAN GENERAL LIFE INSURANCE COMPANY | 175 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 326 | — |
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.