| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLARK INSURANCE Filed as: CLARK & LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DR MERRIMACK, NH 03054 | NATIONWIDE LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| INDIGO INSURANCE SVC3 | 5TH FLOOR 446 MAIN ST WORCESTER, MA 01608 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $22K | $0 | $22K | 7.00% |
| CLARK INSURANCE3 Filed as: CLARK & LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DR MERRIMACK, NH 03054 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $17K | $0 | $17K | 5.44% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE BENEFIT ADMINISTRATORS OF MA CLAIMS PROCESSING | Claims processing Service code 12 | P.O. BOX 55917 BOSTON, MA 02205 | $424K |
| CLARK & LAVEY BENEFITS SOLUTIONS EIN 04-3348257 CONSULTANT/BROKER | Consulting (general) Service code 16 | — | $280K |
| DELTA DENTAL OF MA EIN 04-6143185 CLAIMS PROCESSING | Claims processing Service code 12 | — | $94K |
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 | 760 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 760 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 514 | $56K |
| Life insurance | AMERICAN GENERAL LIFE INSURANCE COMPANY | 766 | $311K |
| Short-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 766 | $311K |
| Long-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 766 | $311K |
| Stop-loss / reinsurancereinsurance | NATIONWIDE LIFE INSURANCE COMPANY | 760 | $1.3M |
| Other | AMERICAN GENERAL LIFE INSURANCE COMPANY | 766 | $311K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 766 | — |
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.