| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 12 GILL STREET, SUITE 5500 WOBURN, MA 01801 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $23K | $5K | $27K | 3.61% |
| GETTYSBURG BENEFITS ADMINISTRATORS3 Filed as: GETTYSBURG BENEFITS ADMINSTRATORS | 777 BALTIMORE STREET, SUITE 97 GETTYSBURG, PA 17325 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $0 | $4K | 11.34% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62937 VIRGINIA BEACH, VA 23466 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $273 | $3K | 8.28% |
| CROHN, BRUCE3 | 9 SOUTH STREET CHESNUT HILL, MA 02467 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $557 | $0 | $557 | 1.46% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62937 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $202 | $3K | 16.05% |
| GETTYSBURG BENEFITS ADMINISTRATORS3 | 777 BALTIMORE STREET, SUITE 97 GETTYSBURG, PA 17325 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 5.90% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 475 KILVERT STREET, BUILDING B SUITE 205 WARWICK, RI 05403 | VISION SERVICE PLAN | $325 | $0 | $325 | 9.99% |
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 | 105 | 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) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 133 | $752K |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 133 | $752K |
| Vision | VISION SERVICE PLAN | 22 | $3K |
| Life insurance(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 105 | $58K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 83 | $38K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 133 | $752K |
| Other(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 105 | $58K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 133 | — |
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.