| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET LOWELL, MA 01851 | TUFTS ASSOCIATED HEALTH MAINTANANCE ORG. INC. | $48K | $715 | $49K | 2.77% |
| FRED C. CHURCH INC.3 Filed as: FRED C CHURCH, INC. | 41 WELLMAN STREET LOWELL, MA 01851 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $653 | $6K | 9.78% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET LOWELL, MA 01851 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $4K | — | $4K | 15.00% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET LOWELL, MA 01851 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $520 | — | $520 | 7.84% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET LOWELL, MA 01851 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $797 | — | $797 | 15.00% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET LOWELL, MA 01851 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $613 | — | $613 | 15.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DENTAL SERVICE OF MASSACHUSETTS INC EIN 04-6143185 THIRD PARTY ADMINISTRATOR | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 465 MEDFORD STREET BOSTON, MA 02129 | $17K |
| FRED C. CHURCH INC. EIN 04-2445292 BROKER | Insurance agents and brokers Service code 22 | 41 WELLMAN STREET LOWELL, MA 01851 | $5K |
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 | 303 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 303 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | TUFTS ASSOCIATED HEALTH MAINTANANCE ORG. INC. | 345 | $1.8M |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 121 | $7K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 303 | $67K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 303 | $90K |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 303 | $68K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 303 | $67K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 345 | — |
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.