| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET CONNECTOR PARK LOWELL, MA 01851 | TUFTS ASSOCIATED HEALTH MAINTENANCE ORG. INC. | $68K | — | $68K | 2.72% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET CONNECTOR PARK LOWELL, MA 01851 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $11K | — | $11K | 15.00% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET CONNECTOR PARK LOWELL, MA 01851 | TUFTS INSURANCE COMPANY | $708 | — | $708 | 2.61% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET CONNECTOR PARK LOWELL, MA 01851 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $2K | — | $2K | 15.01% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET CONNECTOR PARK LOWELL, MA 01851 | EYEMED VISION CARE | $1K | — | $1K | 9.79% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET CONNECTOR PARK LOWELL, MA 01851 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $2K | — | $2K | 15.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DENTAL SERVICE THIRD PARTY ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $27K |
| FRED C. CHURCH INC. EIN 04-2445292 BROKER | Insurance agents and brokers Service code 22 | 41 WELLMAN STREET LOWELL, MA 01851 | $6K |
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 | 330 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 330 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | TUFTS ASSOCIATED HEALTH MAINTENANCE ORG. INC. | 415 | $2.5M |
| Vision | EYEMED VISION CARE | 200 | $14K |
| Life insurance(2 contracts, 2 carriers) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 338 | $11K |
| Short-term disability(2 contracts, 2 carriers) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 330 | $75K |
| Long-term disability(2 contracts, 2 carriers) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 338 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 415 | — |
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.