| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LIVELY INSURANCE BROKERAGE, INC.3 | 1141 SOUTH STREET FITCHBURG, MA 01420 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $43K | — | $43K | 1.12% |
| JOHNSON AND ASSOCIATES3 | 60 THOREAU STREET, SUITE 202 CONCORD, MA 01742 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $43K | — | $43K | 1.12% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $19K | — | $19K | 6.00% |
| LIVELY INSURANCE BROKERAGE, INC.3 | 1141 SOUTH STREET, SUITE 3 FITCHBURG, MA 01420 | AMERICAN FIDELITY ASSURANCE COMPANY | $16K | — | $16K | 5.05% |
| R L TENNANT INSURANCE AGENCY, INC.3 Filed as: R.L. TENNANT INSURANCE AGENCY INC. | 1149 WASHINGTON STREET NEWTON, MA 02460 | AMERICAN FIDELITY ASSURANCE COMPANY | $2K | — | $2K | 0.63% |
| MSADA3 | UNKNOWN BOSTON, MA 02109 | AMERICAN FIDELITY ASSURANCE COMPANY | — | $708 | $708 | 0.22% |
| JOHN V. GIARRATANA JR.3 | PO BOX 255 GEORGETOWN, MA 01833 | AMERICAN FIDELITY ASSURANCE COMPANY | $533 | — | $533 | 0.17% |
| NEW ENGLAND EMPLOYEE BENEFITS CO3 Filed as: NEW ENGLAND AUTO DEALERS | UNKNOWN EAST BRIDGEWATER, MA 02333 | AMERICAN FIDELITY ASSURANCE COMPANY | — | $34 | $34 | 0.01% |
| ROBERT A. LANDRY3 | 4 SEMINOLE CIRCLE ANDOVER, MA 01810 | AMERICAN FIDELITY ASSURANCE COMPANY | -$140 | — | -$140 | -0.04% |
| LIVELY INSURANCE BROKERAGE, INC.3 | 1141 SOUTH STREET FITCHBURG, MA 01420 | DELTA DENTAL OF MASSACHUSETTS | $4K | — | $4K | 1.26% |
| JOHNSON AND ASSOCIATES3 | 60 THOREAU STREET, SUITE 202 CONCORD, MA 01742 | DELTA DENTAL OF MASSACHUSETTS | $4K | — | $4K | 1.26% |
| LIVELY INSURANCE BROKERAGE, INC.3 | 1141 SOUTH STREET FITCHBURG, MA 01420 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 15.39% |
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 | 348 | 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) | 348 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 715 | $4.2M |
| Dental | DELTA DENTAL OF MASSACHUSETTS | 760 | $295K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 46 | $22K |
| Short-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 237 | $315K |
| Long-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 237 | $315K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 715 | $3.9M |
| Other(2 contracts, 2 carriers) | AMERICAN FIDELITY ASSURANCE COMPANY | 237 | $337K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 760 | — |
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.