| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: JENNIFER A. BORISLOW AGENCY INC | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | BLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS, INC. | $143K | $22K | $165K | 2.30% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS, LLC | 669 RIVER DRIVE CENTER LL, SUITE 305 ELMWOOD PARK, NJ 07407 | HARTFORD LIFE AND ACCIDENT | $50K | $21K | $70K | 19.53% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS. SERVICES, INC | 901 MARQUETTE AVENUE, SUITE 1800 MINNEAPOLIS, MN 55402 | HARTFORD LIFE AND ACCIDENT | $72 | $0 | $72 | 0.02% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS. SERVICES, INC | 100 RIALTO PLACE, SUITE 900 MELBOURNE, FL 32901 | HARTFORD LIFE AND ACCIDENT | $0 | -$4K | -$4K | -1.07% |
| ASSUREDPARTNERS3 Filed as: JENNIFER A. BORISLOW AGENCY INC | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | VISION SERVICE PLAN | $2K | $0 | $2K | 3.73% |
| UNIQUE BENEFITS GROUP INC4 | 7 CAPOZZI CIR WOBURN, MA 01801 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $248 | — | $248 | 10.72% |
| HUB INTERNATIONAL MIDWEST LIMITED4 Filed as: HUB INTERNATIONAL NEW ENGLAND | 299 BALLARDVALE STREET WILMINGTON, MA 01887 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $30 | — | $30 | 1.30% |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS, INC. | 887 | $7.2M |
| Dental | BLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS, INC. | 887 | $7.2M |
| Vision | VISION SERVICE PLAN | 352 | $52K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 673 | $359K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 673 | $359K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 673 | $359K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS, INC. | 887 | $7.2M |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 673 | $378K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 887 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.