| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BAYSTATE BENEFIT SERVICES3 Filed as: BAYSTATE BENEFIT SERVICES, INC | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC | $29K | $5K | $34K | 2.35% |
| BAYSTATE BENEFIT SERVICES3 Filed as: BAYSTATE BENEFIT SERVICES, INC | 400 WASHINGTON ST, SUITE 400 BRAINTREE, MA 02184 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC | $4K | — | $4K | 5.27% |
| BAYSTATE BENEFIT SERVICES3 Filed as: BAYSTATE BENEFIT SERVICES, INC | 400 WASHINGTON ST, SUITE 400 BRAINTREE, MA 02184 | MUTUAL OF OMAHA | $8K | — | $8K | 15.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | MUTUAL OF OMAHA | — | $1K | $1K | 2.88% |
| BAYSTATE BENEFIT SERVICES3 Filed as: BAYSTATE BENEFIT SERVICES, INC | 400 WASHINGTON ST, SUITE 400 BRAINTREE, MA 02184 | MUTUAL OF OMAHA | $7K | — | $7K | 15.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | MUTUAL OF OMAHA | — | $1K | $1K | 3.00% |
| BAYSTATE BENEFIT SERVICES3 Filed as: BAYSTATE BENEFIT SERVICES, INC | 400 WASHINGTON ST, SUITE 400 BRAINTREE, MA 02184 | MUTUAL OF OMAHA | $3K | — | $3K | 7.09% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | MUTUAL OF OMAHA | — | $600 | $600 | 1.32% |
| BAYSTATE BENEFIT SERVICES3 Filed as: BAYSTATE BENEFIT SERVICES, INC | 400 WASHINGTON ST, SUITE 400 BRAINTREE, MA 02184 | MUTUAL OF OMAHA | $4K | — | $4K | 15.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | MUTUAL OF OMAHA | — | $678 | $678 | 2.89% |
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 | 104 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 104 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC | 75 | $1.5M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC | 83 | $84K |
| Life insurance(2 contracts) | MUTUAL OF OMAHA | 104 | $99K |
| Long-term disability | MUTUAL OF OMAHA | 104 | $23K |
| Other(3 contracts) | MUTUAL OF OMAHA | 104 | $145K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 104 | — |
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.