| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $124K | $130K | $254K | 2.30% |
| FRED C. CHURCH INC.3 Filed as: FRED C CHURCH, INC | 41 WELLMAN STREET LOWELL, MA 01851 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $42K | $3K | $45K | 0.40% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $10K | — | $10K | 5.32% |
| FRED C. CHURCH INC.3 Filed as: FRED C CHURCH, INC | 41 WELLMAN STREET LOWELL, MA 01851 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $5K | — | $5K | 2.69% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $8K | — | $8K | 5.31% |
| FRED C. CHURCH INC.3 Filed as: FRED C CHURCH, INC. | 41 WELLMAN STREET LOWELL, MA 01851 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $4K | — | $4K | 2.72% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $5K | — | $5K | 5.30% |
| FRED C. CHURCH INC.3 Filed as: FRED C CHURCH, INC. | 41 WELLMAN STREET LOWELL, MA 01851 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $3K | — | $3K | 2.71% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP | 133 FEDERAL STREET FL 2 BOSTON, MA 02110 | VISION SERVICE PLAN | $936 | — | $936 | 1.49% |
| FRED C. CHURCH INC.3 Filed as: FRED C CHURCH, INC. | 41 WELLMAN STREET LOWELL, MA 01851 | VISION SERVICE PLAN | $317 | — | $317 | 0.51% |
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 | 1,127 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 835 | $11.1M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 835 | $11.1M |
| Vision | VISION SERVICE PLAN | 704 | $63K |
| Life insurance | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,074 | $153K |
| Short-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 886 | $196K |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 444 | $100K |
| Other(2 contracts, 2 carriers) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,127 | $179K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,127 | — |
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.