| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LIVELY INSURANCE BROKERAGE, INC.3 | 1141 SOUTH STREET FITCHBURG, MA 01420 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $17K | — | $17K | 1.07% |
| JOHNSON AND ASSOCIATES3 | 60 THOREAU STREET, SUITE 202 CONCORD, MA 01742 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $16K | — | $16K | 1.02% |
| INDIGO INSURANCE SERVICES3 | 446 MAIN STREET, 5TH FLOOR WORCESTER, MA 01742 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $5K | — | $5K | 7.00% |
| LIVELY INSURANCE BROKERAGE, INC.3 | 1141 SOUTH STREET FITCHBURG, MA 01420 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $5K | — | $5K | 6.54% |
| JOHNSON AND ASSOCIATES3 | 60 THOREAU STREET, SUITE 202 CONCORD, MA 01742 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $5K | — | $5K | 6.54% |
| LIVELY INSURANCE BROKERAGE, INC.3 | 1141 SOUTH STREET FITCHBURG, MA 01420 | DELTA DENTAL OF MASSACHUSETTS | $1K | — | $1K | 2.29% |
| JOHNSON AND ASSOCIATES3 | 60 THOREAU STREET, SUITE 202 CONCORD, MA 01742 | DELTA DENTAL OF MASSACHUSETTS | $1K | — | $1K | 2.29% |
| LIVELY INSURANCE BROKERAGE, INC.3 | 1141 SOUTH STREET, SUITE 3 FITCHBURG, MA 01420 | VISION SERVICE PLAN | $302 | — | $302 | 4.27% |
| JOHNSON AND ASSOCIATES3 | 20 MAIN STREET ACTON, MA 01720 | VISION SERVICE PLAN | $302 | — | $302 | 4.27% |
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 | 159 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 159 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 295 | $1.6M |
| Dental | DELTA DENTAL OF MASSACHUSETTS | 0 | $53K |
| Vision | VISION SERVICE PLAN | 63 | $7K |
| Life insurance | AMERICAN GENERAL LIFE INSURANCE COMPANY | 159 | $73K |
| Short-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 159 | $73K |
| Long-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 159 | $73K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 295 | $1.6M |
| Other | AMERICAN GENERAL LIFE INSURANCE COMPANY | 159 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 295 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.