| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INDIGO INSURANCE SERVICES3 | 5TH FLOOR, 446 MAIN STREET WORCESTER, MA 01608 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $21K | — | $21K | 5.81% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD EIN 04-1045815 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $1.4M |
| DELTA DENTAL EIN 04-6143185 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $169K |
| EMPLOYEE P EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $95K |
| THE TRIZETTO GROUP, INC. EIN 33-0761159 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $92K |
| EMPLOYEE A EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $88K |
| VITECH SYSTEMS GROUP, INC. EIN 13-3785492 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $87K |
| MERCER EIN 13-2834414 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $67K |
| EMPLOYEE F EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $65K |
| MODERN ASSISTANCE PROGRAMS, INC. EIN 04-3014253 NONE | Direct payment from the plan; Insurance services Service code 23 | — | $63K |
| MANZI & ASSOCIATES, LLC EIN 04-3508036 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $60K |
| BEST DOCTORS EIN 04-2908444 NONE | Insurance services; Direct payment from the plan Service code 23 | — | $57K |
| EMPLOYEE H EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $56K |
| SEGAL ROITMAN, LLP EIN 04-2489114 NONE | Legal; Direct payment from the plan Service code 29 | — | $48K |
| EMPLOYEE O EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $48K |
| EMPLOYEE B EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $47K |
| STRATEGIC BENEFIT ADVISORS, INC EIN 14-1849341 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $46K |
| MD SASS EIN 13-2704843 NONE | Direct payment from the plan; Investment management Service code 28 | — | $46K |
| EMPLOYEE I EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $46K |
| MORGAN STANLEY EIN 26-4310632 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $43K |
| EMPLOYEE K EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $42K |
| EMPLOYEE G EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $42K |
| EMPLOYEE D EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $39K |
| THE BOSTON COMPANY EIN 04-3404987 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $35K |
| EMPLOYEE J EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $34K |
| CVS PHARMACY, INC EIN 05-0340626 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $29K |
| MARCUM EIN 11-1986323 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $29K |
| THE SAVITZ ORGANIZATION EIN 26-1371674 NONE | Consulting (general); Actuarial; Consulting fees; Direct payment from the plan Service code 11 | — | $28K |
| EMPLOYEE L EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $27K |
| EMPLOYEE N EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $27K |
| EMPLOYEE S EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $26K |
| STATE STREET BANK & TRUST CO EIN 04-1867445 NONE | Investment management fees paid indirectly by plan; Non-monetary compensation; Other fees; Custodial (securities); Investment management fees paid directly by plan Service code 19 | — | $25K |
| DAVIS VISION, INC. EIN 11-3051991 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $24K |
| EMPLOYEE R EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $21K |
| EMPLOYEE E EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $18K |
| EMPLOYEE C EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $16K |
| SEGAL ROGERSCASEY EIN 13-1835864 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $15K |
| INNOVATIVE SYSTEMS & SOLUTIONS EIN 04-3238118 NONE | Other services; Direct payment from the plan Service code 49 | — | $11K |
| IRON MOUNTAIN RECORDS MANAGEMENT EIN 04-3038590 NONE | Other services; Direct payment from the plan Service code 49 | — | $10K |
| STENHOUSE CONSULTING EIN 05-0517648 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $10K |
| WALLINGFORD PRODIGY INC NONE | Other services; Direct payment from the plan Service code 49 | — | $6K |
| EMPLOYEE Q EIN 04-6040880 EMPLOYEE | Employee (plan) Service code 30 | — | $6K |
| STATE STREET GLOBAL ADVISORS EIN 04-1867445 NONE | Investment management fees paid directly by plan; Soft dollars commissions; Other fees; Custodial (other than securities); Investment management fees paid indirectly by plan; Custodial (securities) Service code 18 | — | $4K |
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 | 2,736 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 42 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,778 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AMERICAN GENERAL LIFE INSURANCE COMPANY | 2,278 | $370K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 2,801 | $471K |
| Other | AMERICAN GENERAL LIFE INSURANCE COMPANY | 2,278 | $370K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,801 | — |
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.