| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | TUFTS HEALTH PLAN | $25K | $651 | $25K | 2.33% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | TUFTS HEALTH PLAN | $9K | $366 | $9K | 1.29% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | SYMETRA | $21K | $7K | $27K | 11.11% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: INDIGO INSURANCE SERVIES | 100 FRONT STREET WORCESTER, MA 01608 | SYMETRA | $12K | — | $12K | 5.06% |
| NATIONAL BENEFITS CENTER LLC3 Filed as: NATIONAL BENEFITS CENTER | — | SYMETRA | — | $3K | $3K | 1.05% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | DELTA DENTAL | $3K | — | $3K | 2.56% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | EYEMED VISON CARE( FIDELITY SECURITY LIFE INSURANCE) | $1K | — | $1K | 10.77% |
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 | 254 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 255 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL | 254 | $117K |
| Vision | EYEMED VISON CARE( FIDELITY SECURITY LIFE INSURANCE) | 182 | $10K |
| Life insurance | SYMETRA | 200 | $245K |
| Short-term disability | SYMETRA | 200 | $245K |
| Long-term disability | SYMETRA | 200 | $245K |
| Other | SYMETRA | 200 | $245K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 254 | — |
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.