| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | HEALTH NEW ENGLAND | $54K | — | $54K | 3.10% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $1K | $6K | 16.89% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 2.72% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $1K | $5K | 13.23% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 2.77% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | EYEMED VISION CARE (ON BEHALF OF FIDELITY SECURITY LIFE INS. CO.) | $2K | — | $2K | 10.75% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $475 | $2K | 13.21% |
| NATIONAL COMMERCE BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $407 | $407 | 2.75% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $447 | $2K | 14.08% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $383 | $383 | 3.50% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $610 | — | $610 | 15.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MA CLAIMS PROCESSING | Claims processing Service code 12 | 101 HUNTINGTON AVENUE SUITE 1300 BOSTON, MA 02199 | $23K |
| BAYSTATE BENEFIT SERVICES BROKER | Other commissions Service code 55 | 400 WASHINGTON ST SUITE 400 BRAINTREE, MA 02184 | $7K |
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 | 0 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH NEW ENGLAND | 192 | $1.7M |
| Vision | EYEMED VISION CARE (ON BEHALF OF FIDELITY SECURITY LIFE INS. CO.) | 256 | $16K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 249 | $15K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 15 | $11K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 249 | $36K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 249 | $57K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 256 | — |
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.