| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET LOWELL, MA 01851 | TUFTS ASSOCIATED HEALTH MAINTANANCE ORG., INC. | $23K | $400 | $24K | 2.36% |
| FRED C. CHURCH INC.3 Filed as: FRED C. CHURCH, INC. | 41 WELLMAN STREET LOWELL, MA 01851 | TUFTS INSURANCE COMPANY | $4K | $72 | $4K | 2.29% |
| FRED C. CHURCH INC.3 Filed as: FRED C. CHURCH, INC. | 41 WELLMAN STREET LOWELL, MA 01851 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $4K | — | $4K | 5.19% |
| FRED C. CHURCH INC.3 Filed as: FRED C. CHURCH, INC. | 41 WELLMAN STREET LOWELL, MA 01851 | AETNA LIFE INSURANCE CO. | $3K | — | $3K | 13.44% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CHOICE STRATEGIES EIN 54-2075442 THIRD PARTY ADMINISTRATOR | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | PO BOX 225 SOUTH BURLINGTON, VT 05407 | $8K |
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 | 205 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 205 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | TUFTS ASSOCIATED HEALTH MAINTANANCE ORG., INC. | 158 | $1.2M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 110 | $77K |
| Life insurance | AETNA LIFE INSURANCE CO. | 205 | $26K |
| Long-term disability | AETNA LIFE INSURANCE CO. | 205 | $26K |
| Other | AETNA LIFE INSURANCE CO. | 205 | $26K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 205 | — |
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.