| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WILLIAM GALLAGHER ASSOCIATES | INSURANCE BROKER 470 ATLANTIC AVENUE BOSTON, MA 02210 | SYMETRA LIFE INSURANCE COMPANY | — | $6K | $6K | 1.04% |
| C2 CENTRIC LLC3 | PO BOX 6824 GRAND RAPIDS, MI 49516 | SYMETRA LIFE INSURANCE COMPANY | — | $4K | $4K | 0.66% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WILLIAM GALLAGHER ASSOCIATES | INSURANCE BROKERS 470 ATLANTIC AVENUE BOSTON, MA 02210 | SYMETRA LIFE INSURANCE COMPANY | — | $1K | $1K | 0.21% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WILLIAM GALLAGHER ASSOCIATES | C/O JAMES P SMITH 470 ATLANTIC AVENUE 13TH FL BOSTON, MA 02210 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $12K | $12K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WILLIAM GALLAGHER ASSOCIATES | C/O JAMES P SMITH 470 ATLANTIC AVENUE, 13TH FL BOSTON, MA 02210 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $3K | $3K | 5.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSPHERE CIR CHICAGO, IL 60674 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 20.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MASSACHUS EIN 04-1045815 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | — | $342K |
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 | 653 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 661 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | SYMETRA LIFE INSURANCE COMPANY | 532 | $1.1M |
| Dental(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | 1,456 | $363K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 653 | $240K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 653 | $240K |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 532 | $584K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 653 | $302K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,456 | — |
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.