| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EASTERN INSURANCE GROUP LLC3 | — | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $65K | $33K | $98K | 2.01% |
| EASTERN INSURANCE GROUP LLC3 | PO BOX 4000 WAKEFIELD, MA 01880 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $28K | — | $28K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 400 MIDLAND DRIVE SUITE 300 MT LAUREL, NJ 08054 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $477 | — | $477 | 0.08% |
| AXA ASSISTANCE, USA5 Filed as: AXA ASSISTANCE USA | 122 SOUTH MICHIGAN AVE SUITE 1100 CHICAGO, IL 60603 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $162 | $162 | 0.03% |
| EASTERN INSURANCE GROUP LLC3 | PO BOX 4000 WAKEFIELD, MA 01880 | DELTA DENTAL OF MASSACHUSETTS | $12K | — | $12K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE PRUDENTIAL INSURANCE COMPANY OF EIN 22-1211670 REIMBURSEMENT FOR ADMIN S | Other fees Service code 99 | AMERICA PO BOX 7827 PHILADELPHIA, PA 19176 | $15K |
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 | 996 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 996 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 996 | $4.9M |
| Dental | DELTA DENTAL OF MASSACHUSETTS | 1,046 | $0 |
| Life insurance | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 476 | $564K |
| Long-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 476 | $564K |
| Other | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 476 | $564K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,046 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.