| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE AGENCY, INC. | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $40K | $10K | $50K | 2.18% |
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE AGENCY, INC. | ONE GRIFFIN BROOK DRIVE, 2ND FLOOR METHUEN, MA 01844 | DELTA SERVICE OF MASSACHUSETTS, INC. DBA DELTA DENTAL OF MA | $6K | $0 | $6K | 3.33% |
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE AGENCY, INC. | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | SUN LIFE ASSURANCE COMPANY OF CANADA | $8K | $0 | $8K | 7.76% |
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE AGENCY, INC. | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $0 | $9K | 18.44% |
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE AGENCY, INC. | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $2K | $0 | $2K | 9.94% |
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE AGENCY, INC. | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | FOUR EVER LIFE INSURANCE COMPANY | $522 | $278 | $800 | 23.00% |
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 | 190 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 191 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 345 | $2.3M |
| Dental | DELTA SERVICE OF MASSACHUSETTS, INC. DBA DELTA DENTAL OF MA | 390 | $174K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 251 | $17K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 190 | $109K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 190 | $109K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 190 | $109K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 345 | $2.3M |
| Other(3 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 190 | $160K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 390 | — |
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.