| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EASTERN INSURANCE GROUP LLC3 | 607 NORTH AVENUE WAKEFIELD, MA 01880 | BLUE CROSS BLUE SHIELD OF MA | $21K | — | $21K | 1.32% |
| GROUP INSURANCE SOLUTIONS, INC.3 | 33 BOSTON POST ROAD WEST SUITE 120 MARLBOROUGH, MA 01752 | BLUE CROSS BLUE SHIELD OF MA | $9K | — | $9K | 0.57% |
| GROUP INSURANCE SOLUTIONS, INC.3 | 33 BOSTON POST ROAD WEST SUITE 120 MARLBOROUGH, MA 01752 | TUFTS ASSOCIATED HEALTH MAINTENANCE ORG. INC. | $12K | — | $12K | 7.98% |
| EASTERN INSURANCE GROUP LLC3 Filed as: EASTERN INSURANCE GROUP | ATTN BENEFITS DEPT PO BOX 4000 WAKEFIELD, MA 01880 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $1K | $4K | 6.78% |
| GROUP INSURANCE SOLUTIONS, INC.3 Filed as: GROUP INSURANCE SOLUTIONS, INC | 33 BOSTON POST ROAD WEST SUITE 120 MARLBOROUGH, MA 01752 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $943 | — | $943 | 1.71% |
| EASTERN INSURANCE GROUP LLC3 Filed as: EASTERN INSURANCE GROUP | ATTN BENEFITS DEPT PO BOX 4000 WAKEFIELD, MA 01880 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $453 | $2K | 10.82% |
| GROUP INSURANCE SOLUTIONS, INC.3 | 33 BOSTON POST ROAD WEST SUITE 120 MARLBOROUGH, MA 01752 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 4.60% |
| GROUP INSURANCE SOLUTIONS, INC.3 | 33 BOSTON POST ROAD WEST SUITE 120 MARLBOROUGH, MA 01752 | DENTAL SERVICE OF MASSACHUSETTS, INC. D/B/A DELTA DENTAL OF MA | $1K | — | $1K | 5.52% |
| THERESA PAGNINI3 | 110 CARLETON AVE WHITMAN, MA 02382 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $3 | $1K | 12.24% |
| JAMES R SMITH INSURANCE LTD3 | 5835 POST ROAD EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $96 | $90 | $186 | 2.09% |
| DAVID L FLEURY3 | C/O COLONIAL SUPPLEMENTAL INS. PROVIDENCE, RI 02903 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $53 | $25 | $78 | 0.88% |
| DONNA LEE JORDAN3 | 18 FORGE ROAD KINGSTON, MA 02364 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $35 | — | $35 | 0.39% |
| ROBERT D STEBBINS3 | 25 STANDISH AVE SCITUATE, MA 02066 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $28 | — | $28 | 0.31% |
| RICHARD HASKINS3 | 22 WEST STREET MILLBURY, MA 01527 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.15% |
| PATRICIA O'BRIEN3 Filed as: PATRICIA BURNS | 399 POND STREET STE5F BRAINTREE, MA 02184 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.02% |
| EASTERN INSURANCE GROUP LLC3 Filed as: EASTERN INSURANCE GROUP | ATTN BENEFITS DEPT PO BOX 4000 WAKEFIELD, MA 01880 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $351 | $102 | $453 | 9.06% |
| GROUP INSURANCE SOLUTIONS, INC.3 Filed as: GROUP INSURANCE SOLUTIONS, INC | 33 BOSTON POST ROAD WEST SUITE 120 MARLBOROUGH, MA 01752 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $250 | — | $250 | 5.00% |
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 | 157 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 159 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MA | 277 | $1.7M |
| Dental(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MA | 290 | $1.6M |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 157 | $64K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 12 | $9K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 157 | $22K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MA | 277 | $1.7M |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 157 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 290 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.