| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET BRAINTREE, MA 02184 | HEALTH NEW ENGLAND | $31K | — | $31K | 2.94% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET BRAINTREE, MA 02184 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | $5K | — | $5K | 4.30% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET BRAINTREE, MA 02184 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $437 | $3K | 10.35% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET BRAINTREE, MA 02184 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $311 | $2K | 10.39% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET BRAINTREE, MA 02184 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $357 | $3K | 14.72% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET BRAINTREE, MA 02184 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $473 | — | $473 | 3.50% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET BRAINTREE, MA 02184 | EYEMED VISION CARE (ON BEHALF OF FIDELITY SECURITY LIFE INS. CO.) | $823 | — | $823 | 11.15% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET BRAINTREE, MA 02184 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $388 | $34 | $422 | 16.31% |
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 | 185 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 186 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH NEW ENGLAND | 131 | $1.1M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | 284 | $108K |
| Vision | EYEMED VISION CARE (ON BEHALF OF FIDELITY SECURITY LIFE INS. CO.) | 131 | $7K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 185 | $24K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 58 | $26K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 181 | $23K |
| Other(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 185 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 284 | — |
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.