| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GROUP BROKERAGE INS. AGENCY LLC3 Filed as: GROUP BROKERAGE INS AGENCY | 69 CARLETON RD BELMONT, MA 02478 | HARVARD PILGRIM HEALTH CARE | $76K | — | $76K | 2.70% |
| JOHN E O'REILLY3 Filed as: JOHN F SIRACUSA | 69 CARELTON ROAD BELMONT, MA 02478 | HARVARD PILGRIM HEALTH CARE | $36K | — | $36K | 1.27% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY SE STE 1950 ATLANTA, GA 30339 | HARVARD PILGRIM HEALTH CARE | $693 | — | $693 | 0.02% |
| JOHN E O'REILLY3 Filed as: JOHN F SIRACUSA | 69 CARELTON ROAD BELMONT, MA 02478 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 2.26% |
| GROUP BROKERAGE INS. AGENCY LLC3 Filed as: GROUP BROKERAGE INS AGENCY | 69 CARLETON RD BELMONT, MA 02478 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 1.54% |
| JOHN FRANK SIRACUSA3 Filed as: JOHN SIRACUSA | 69 CARLETON RD BELMONT, MA 02478 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | — | $1K | 9.12% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HRC TOTAL SOLUTIONS EIN 30-0041952 HRA/FSA ADMIN | Contract Administrator; Other commissions; Claims processing Service code 12 | 111 CHARLES STREET MANCHESTER, NH 03101 | $17K |
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 | 247 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 253 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HARVARD PILGRIM HEALTH CARE | 528 | $2.8M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 391 | $501K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 208 | $13K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 391 | $501K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 391 | $501K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 391 | $501K |
| Prescription drug | HARVARD PILGRIM HEALTH CARE | 528 | $2.8M |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 391 | $501K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 528 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.