| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EASTERN BENEFITS GROUP3 | 233 WEST CENTRAL STREET NATICK, MA 01760 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $25K | $7K | $32K | 3.04% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 115 FEDERAL STREET BOSTON, MA 02110 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $10K | $0 | $10K | 0.92% |
| EASTERN BENEFITS GROUP3 | 233 WEST CENTRAL STREET NATICK, MA 01760 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $3K | $8K | 18.92% |
| EASTERN BENEFITS GROUP3 | PO BOX 4000 WAKEFIELD, MA 01880 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $684 | $0 | $684 | 9.30% |
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 | 74 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 78 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 154 | $1.0M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 154 | $1.0M |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 80 | $7K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 74 | $45K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 74 | $45K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 74 | $45K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 154 | $1.0M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 74 | $45K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 154 | — |
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.