| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UNKNOWN3 | — | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | $20K | — | $20K | 1.81% |
| GROUP BROKERAGE INSURANCE AGENCY3 | 135 BEAVER ST., STE. 404 WALTHAM, MA 02452 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | $5K | $4K | $9K | 0.79% |
| DIGITAL INSURANCE LLC Filed as: DIGITAL INSURANCE INC. | 200 GALLERIA PKWY., STE. 1950 ATLANTA, GA 30339 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | $3K | — | $3K | 0.25% |
| UNKNOWN3 | — | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | $3K | — | $3K | 2.64% |
| GROUP BROKERAGE INSURANCE AGENCY3 | 135 BEAVER ST., STE. 404 WALTHAM, MA 02452 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | $932 | — | $932 | 0.84% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC. | 200 GALLERIA PKWY, STE. 1950 ATLANTA, GA 30339 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | $662 | — | $662 | 0.60% |
| JOHN FRANK SIRACUSA3 | 129 MT. AUBURN ST. CAMBRIDGE, MA 02138 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 10.25% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC. | 315 E ROBINSON ST., STE. 325 ORLANDO, FL 32801 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 5.34% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC. | 200 GALLERIA PKWY., STE. 1950 ATLANTA, GA 30339 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $320 | $320 | 0.68% |
| GROUP BROKERAGE INSURANCE AGENCY3 | 135 BEAVER ST., STE. 404 WALTHAM, MA 02452 | VISION SERVICE PLAN | $566 | — | $566 | 6.91% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC. | 200 GALLERIA PKWY., STE. 1950 ATLANTA, GA 30339 | VISION SERVICE PLAN | $94 | — | $94 | 1.15% |
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 | 141 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 143 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | 219 | $1.1M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | 256 | $111K |
| Vision | VISION SERVICE PLAN | 67 | $8K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 141 | $47K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 141 | $47K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 141 | $47K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 256 | — |
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.