| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLARK INSURANCE3 Filed as: CLARK AND LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DRIVE MERRIMACK, NH 03054 | BLUE CROSS BLUE SHIELD OF MA | $15K | $2K | $17K | 2.65% |
| JOHN FRANK SIRACUSA Filed as: JOHN SIRACUSA | 129 MT AUBURN STREET CAMBRIDGE, MA 02138 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $30K | $0 | $30K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE BENEFIT ADMINISTRATORS OF MA EIN 04-1045815 THIRD PARTY ADMINSTRATOR | Claims processing Service code 12 | P.O. BOX 55917 BOSTON, MA 02205 | $365K |
| CLARK & LAVEY BENEFITS SOLUTION EIN 04-3348257 BROKER/CONSULTANT | Other commissions Service code 55 | 7 HENRY CLAY DRIVE MERRIMACK, NH 03054 | $350K |
| JOHN SIRACUSA GROUP BROKERAGE INSUR EIN 82-1052357 BROKER/AGENT | Insurance agents and brokers Service code 22 | 129 MR. AUBURN STREET CAMBRIDGE, MA 02138 | $30K |
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 | 663 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 663 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUE CROSS BLUE SHIELD OF MA | 1,366 | $622K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 539 | $201K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 539 | $201K |
| Stop-loss / reinsurancereinsurance | NATIONWIDE | 667 | $2.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,366 | — |
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.