| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLUE BENEFIT ADMINISTRATORS OF MASS5 Filed as: BLUE BENEFIT ADMINISTRATOR OF MA | P.O. BOX 55917ITE 1100 BOSTON, MA 022055917 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $0 | $131K | $131K | 30.39% |
| ASSUREDPARTNERS3 Filed as: NORTHWESTERN BENEIFT CORP OF GA | 3438 PEACHTREE ROAD PHIPPS TOWER, SUITE 1100 ATLANTA, GA 30326 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $38K | — | $38K | 8.70% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: NORTHWESTERN BENEFIT CORP OF GA | PHIPPS TOWER SUITE 1100 3438 PEACHTREE ROAD ATLANTA, GA 303261555 | MUTUAL OF OMAHA | $7K | $2K | $9K | 13.25% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: NORTHWESTERN BENEFIT CORP OF GA | PHIPPS TOWER SUITE 1100 3438 PEACHTREE ROAD ATLANTA, GA 303261555 | MUTUAL OF OMAHA | $3K | $1K | $4K | 13.39% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: NORTHWESTERN BENEFIT CORP OF GA | PHIPPS TOWER SUITE 1100 3438 PEACHTREE ROAD ATLANTA, GA 30326 | EYEMED VISION CARE OR FIDELITY SECURITY LIFE INSURANCE COMPANY | $3K | — | $3K | 10.03% |
| ASSUREDPARTNERS3 Filed as: NORTHWESTERN BENFIT CORP OF GA | PHIPPS TOWER SUITE 1100 3438 PEACHTREE ROAD ATLANTA, GA 303261555 | MUTUAL OF OMAHA | $3K | $839 | $3K | 13.18% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: NORTHWESTERN BENEFIT CORP OF GA | PHIPPS TOWER SUITE 1100 3438 PEACHTREE ROAD ATLANTA, GA 303261555 | MUTUAL OF OMAHA | $2K | $633 | $2K | 13.43% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MASSACHUS EIN 04-1048515 INSURANCE AGENT | Insurance services Service code 23 | LANDMARK CENTER 401 PARK DRIVE ATLANTA, GA 30326 | $26K |
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 | 241 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 242 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 226 | $431K |
| Vision | EYEMED VISION CARE OR FIDELITY SECURITY LIFE INSURANCE COMPANY | 308 | $27K |
| Life insurance(2 contracts) | MUTUAL OF OMAHA | 241 | $49K |
| Short-term disability | MUTUAL OF OMAHA | 241 | $68K |
| Long-term disability | MUTUAL OF OMAHA | 216 | $26K |
| Other(2 contracts) | MUTUAL OF OMAHA | 241 | $49K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 308 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.