| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WILLIAM GALLAGHER ASSOCIATES | 470 ATLANTIC AVENUE BOSTON, MA 02210 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $114K | $59K | $172K | 2.17% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WILLIAM GALLAGHER ASSOCIATES | 470 ATLANTIC AVENUE BOSTON, MA 02210 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | — | $183 | $183 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WILLIAM GALLAGHER ASSOCIATES | 470 ATLANTIC AVENUE BOSTON, MA 02210 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $16K | — | $16K | 2.36% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WILLIAM GALLAGHER ASSOCIATES | 470 ATLANTIC AVENUE BOSTON, MA 02210 | HARTFORD LIFE AND ACCIDENT | $20K | — | $20K | 3.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WILLIAM GALLAGHER ASSOCIATES | 470 ATLANTIC AVENUE BOSTON, MA 02210 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $4K | — | $4K | 2.92% |
| AON CONSULTING INC3 Filed as: AON CONSULTING, INC. | 199 WATER STREET, 12TH FLOOR NEW YORK, NY 10038 | HARTFORD LIFE & ACCIDENT CO. | $771 | $23 | $794 | 15.44% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| STATE STREET BANK EIN 04-0025081 INVESTMENT MANAGER | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $67K |
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 | 655 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 98 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 753 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 1,652 | $7.9M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 1,675 | $690K |
| Vision | VISION SERVICE PLAN | 584 | $77K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 655 | $580K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 655 | $580K |
| Other(3 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 655 | $735K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,675 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.