| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GREGORY B JOHNSON3 | UNKNOWN ACTON, MA 01720 | BLUE CROSS BLUE SHEILD OF MASSACHUSETTS | $77K | $0 | $77K | 1.37% |
| LIVELY INSURANCE BROKERAGE, INC.3 | UNKNOWN ACTON, MA 01720 | BLUE CROSS BLUE SHEILD OF MASSACHUSETTS | $9K | $0 | $9K | 0.15% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P.O. BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $13K | $0 | $13K | 3.62% |
| LIVELY INSURANCE BROKERAGE, INC.3 | 1141 SOUTH STREET #3 FITCHBURG, MA 01420 | AMERICAN FIDELITY ASSURANCE COMPANY | $8K | $0 | $8K | 2.37% |
| LIVELY INSURANCE BROKERAGE, INC.3 Filed as: LIVELY INSURANCE BROKERAGE INC | 1141 SOUTH STREET #3 FITCHBURG, MA 01420 | AMERICAN FIDELITY ASSURANCE COMPANY | $4K | $0 | $4K | 1.28% |
| LIVELY INSURANCE BROKERAGE, INC.3 | 1141 SOUTH STREET, SUITE 3 FITCHBURG, MA 01420 | AMERICAN FIDELITY ASSURANCE COMPANY | $4K | $0 | $4K | 1.14% |
| AMERICAN FIDELITY GENERAL AGENCY3 Filed as: AMERICAN FIDELITY, INC. | PO BOX 25360 OKLAHOMA CITY, OK 731250360 | AMERICAN FIDELITY ASSURANCE COMPANY | $3K | $0 | $3K | 0.81% |
| 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 | $3K | $0 | $3K | 0.77% |
| AMERICAN FIDELITY GENERAL AGENCY3 Filed as: AMERICAN FIDELITY, INC. | PO BO X25360 OKLAHOMA CITY, OK 731250360 | AMERICAN FIDELITY ASSURANCE COMPANY | $2K | $0 | $2K | 0.44% |
| LIVELY INSURANCE BROKERAGE, INC.3 Filed as: LIVELY INSURANCE GROUP | 1141 SOUTH STREET #3 FITCHBURG, MA 01420 | AMERICAN FIDELITY ASSURANCE COMPANY | $1K | $0 | $1K | 0.39% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P.O. BOX 2560 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $1K | $0 | $1K | 0.39% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICA FIDELITY ASSURANCE COMPANY | P.O. BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $1K | $0 | $1K | 0.34% |
| MSADA3 | UNKNOWN ACTON, MA 01720 | AMERICAN FIDELITY ASSURANCE COMPANY | $0 | $560 | $560 | 0.16% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P. O. BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $398 | $0 | $398 | 0.11% |
| MSADA3 | ROBERT O'KONIEWSKI EXEC VP BOSTON, MA 02109 | AMERICAN FIDELITY ASSURANCE COMPANY | $0 | $278 | $278 | 0.08% |
| R L TENNANT INSURANCE AGENCY, INC.3 | 1149 WASHINGTON STREET NEWPORT, MA 02460 | AMERICAN FIDELITY ASSURANCE COMPANY | $248 | $0 | $248 | 0.07% |
| JOHN V. GIARRATANA JR.3 Filed as: JOHN GIARRATANA JR V | 222 CAPE POINTE CIRCLE JUPITER, FL 33477 | AMERICAN FIDELITY ASSURANCE COMPANY | $82 | $0 | $82 | 0.02% |
| JOHN V. GIARRATANA JR.3 Filed as: JOHN GIARRATANA JR. V | 222 CAPE POINTE CIRCLE JUPITER, FL 33477 | AMERICAN FIDELITY ASSURANCE COMPANY | $79 | $0 | $79 | 0.02% |
| R L TENNANT INSURANCE AGENCY, INC.3 Filed as: RL TENNANT INSURANCE AGENCY INC | 1149 WASHINGTON STREET NEWTON, MA 02460 | AMERICAN FIDELITY ASSURANCE COMPANY | $78 | $0 | $78 | 0.02% |
| JOHN V. GIARRATANA JR.3 Filed as: JOHN V GIARRATANA JR. | 222 CAPE POINTE CIRCLE JUPITER, FL 33477 | AMERICAN FIDELITY ASSURANCE COMPANY | $76 | $0 | $76 | 0.02% |
| JOHN V. GIARRATANA JR.3 Filed as: JOHN V GIARRATANA JR | 222 CAPE POINT CIRCLE JUPITER, FL 33477 | AMERICAN FIDELITY ASSURANCE COMPANY | $66 | $0 | $66 | 0.02% |
| JOHN V. GIARRATANA JR.3 Filed as: JOHN V GIARRATANA JR | 222 CAPE POINTE CIRCLE JUPITER, FL 33477 | AMERICAN FIDELITY ASSURANCE COMPANY | $30 | $0 | $30 | 0.01% |
| JOHN V. GIARRATANA JR.3 | 222 CAPE POINTE CIRCLE JUPITER, FL 33477 | AMERICAN FIDELITY ASSURANCE COMPANY | $25 | $0 | $25 | 0.01% |
| MSADA3 | UNKNOWN NEWTON, MA 01720 | AMERICAN FIDELITY ASSURANCE COMPANY | $0 | $11 | $11 | 0.00% |
| JOHN V. GIARRATANA JR.3 Filed as: JOHN V GIARRANTANA JR | 222 CAPE POINTE CIRCLE JUPITER, FL 33477 | AMERICAN FIDELITY ASSURANCE COMPANY | $9 | $0 | $9 | 0.00% |
| LIVELY INSURANCE BROKERAGE, INC.3 | 1141 SOUTH STREET FITCHBURG, MA 01420 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 14.79% |
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 | 375 | 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) | 375 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHEILD OF MASSACHUSETTS | 824 | $6.0M |
| Dental | BLUE CROSS BLUE SHEILD OF MASSACHUSETTS | 824 | $5.6M |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 38 | $18K |
| Short-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 45 | $349K |
| Long-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 45 | $349K |
| Prescription drug | BLUE CROSS BLUE SHEILD OF MASSACHUSETTS | 824 | $5.6M |
| Other(2 contracts, 2 carriers) | AMERICAN FIDELITY ASSURANCE COMPANY | 45 | $368K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 824 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.