| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROSS INSURANCE3 | 1100 ELM STREET MANCHESTER, NH 03101 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $41K | $5K | $46K | 3.19% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE INC | 275 PROMENADE STREET, SUITE 135 PROVIDENCE, ME 02908 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $0 | $7K | 11.09% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE INC | PO BOX 1388 BANGOR, ME 04402 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $501 | $0 | $501 | 3.48% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE INC | 275 PROMENADE STREET, SUITE 135 PROVIDENCE, ME 02908 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $145 | $0 | $145 | 1.01% |
| ACCESS ENROLL3 | 33 LANDAU ROAD PLAINVILLE, MA 02762 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $136 | $0 | $136 | 0.94% |
| CHRISTOPHER SMITH3 | 798 BERRY ROAD NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $50 | $0 | $50 | 0.35% |
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 | 108 | 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) | 108 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 180 | $1.4M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 180 | $1.4M |
| Vision | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 180 | $1.4M |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 108 | $61K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 36 | $14K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 108 | $61K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 180 | $1.4M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 108 | $76K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 180 | — |
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.