| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLARK INSURANCE3 Filed as: CLARK & LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DRIVE MERRIMACK, NH 03054 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $5K | $0 | $5K | 3.65% |
| CLARK INSURANCE3 Filed as: CLARK & LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DRIVE MERRIMACK, NH 03054 | MONY LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 12.25% |
| INDIGO INSURANCE SERVICES3 | INDIGO INSURANCE SERVICES WORCESTER, MA 01608 | MONY LIFE INSURANCE COMPANY OF AMERICA | — | $6K | $6K | 8.35% |
| CLARK INSURANCE3 Filed as: CLARK & LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DRIVE MERRIMACK, NH 03054 | VSP VISION SERVICE PLAN | $889 | $0 | $889 | 5.88% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTH PLANS INC EIN 04-2734278 THIRD PARTY ADMINISTRATOR | Claims processing; Other services Service code 12 | — | $104K |
| CLARK & LAVEY BENEFITS SOLUTIONS EIN 04-3348257 BROKER/CONSULTANT | Insurance agents and brokers Service code 22 | — | $59K |
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 | 152 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 152 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 332 | $139K |
| Vision | VSP VISION SERVICE PLAN | 127 | $15K |
| Life insurance | MONY LIFE INSURANCE COMPANY OF AMERICA | 165 | $67K |
| Short-term disability | MONY LIFE INSURANCE COMPANY OF AMERICA | 165 | $67K |
| Long-term disability | MONY LIFE INSURANCE COMPANY OF AMERICA | 165 | $67K |
| Stop-loss / reinsurancereinsurance | NATIONWIDE LIFE INSURANCE COMPANY | 152 | $740K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 332 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.