| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TRUE NORTH COMPANIES LC3 Filed as: TRUE NORTH INSURANCE AGENCY | 85 MAIN ST STE 110 NORTH ADAMS, MA 01247 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $16K | $16K | 1.66% |
| TRUE NORTH COMPANIES LC3 Filed as: TRUE NORTH INSURANCE AGENCY | 85 MAIN ST STE 110 NORTH ADAMS, MA 01247 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $16K | $16K | 1.70% |
| TRUE NORTH COMPANIES LC3 Filed as: TRUE NORTH INSURANCE AGENCY | 85 MAIN STREET STE 110 NORTH ADAMS, MA 01247 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $20K | $16K | $35K | 3.79% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY SE STE 1950 ATLANTA, GA 30339 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 0.38% |
| TRUE NORTH COMPANIES LC3 Filed as: TRUE NORTH INSURANCE AGENCY | 85 MAIN ST STE 110 NORTH ADAMS, MA 01247 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 1.77% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MA EIN 04-1045815 HEALTH/DTL PROVIDER | Direct payment from the plan; Insurance agents and brokers; Float revenue; Contract Administrator; Claims processing; Participant communication; Other services Service code 12 | 101 HUNTINGTON AVE STE 1300 BOSTON, MA 021997611 | $1.9M |
| HEALTH NEW ENGLAND EIN 04-3012347 HEALTH PROVIDER | Claims processing; Other services; Float revenue; Participant communication; Contract Administrator; Insurance agents and brokers; Direct payment from the plan Service code 12 | ONE MONARCH PLACE SUITE 2500 SPRINGFIELD, MA 011441500 | $382K |
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 | 2,825 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,837 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC | 7 | $18K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,742 | $977K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,144 | $944K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,825 | $933K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,742 | $128K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,825 | — |
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.