| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 | UKNOWN UNKNOWN, MA 00000 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $49K | $15K | $64K | 2.02% |
| MARSH & MCLENNAN AGENCY LLC3 | UNKNOWN UNKNOWN, MA 00000 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $5K | — | $5K | 1.57% |
| INDIGO INSURANCE SERVICES3 | 101 HUNTINGTON AVENUE BOSTON, MA 02199 | USABLE LIFE | $5K | — | $5K | 17.00% |
| INDIGO INSURANCE SERVICES3 | 101 HUNTINGTON AVENUE BOSTON, MA 02199 | USABLE LIFE | $900 | — | $900 | 16.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ZENITH AMERICAN SOLUTIONS, INC. EIN 52-1590516 NONE | Plan Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 14 | 10 TECHNOLOGY DRIVE WALLINGFORD, CT 06492 | $51K |
| ROBERT M. CHEVERIE & ASSOCIATES EIN 06-1335139 NONE | Legal; Direct payment from the plan Service code 29 | 333 E RIVER DR EAST HARTFORD, CT 06108 | $24K |
| NOVAK FRANCELLA, LLC EIN 61-1436956 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | 255 ROUTE 80 KILLINGWORTH, CT 06419 | $22K |
| MORGAN STANLEY GLOBAL BANKING EIN 36-3145972 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | TWO JERICHO PLAZA JERICHO, NY 11753 | $10K |
| SEGAL COMPANY EIN 13-2646110 NONE | Direct payment from the plan; Actuarial Service code 11 | 116 HUNTINGTON AVE BOSTON, MA 02116 | $10K |
| BLUE CROSS BLUE SHIELD OF MA EIN 04-1045815 NONE | Other services; Claims processing Service code 12 | 101 HUNTINGTON AVE SUITE 1300 BOSTON, MA 02199 | $0 |
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 | 254 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 124 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 378 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 407 | $3.6M |
| Life insurance | USABLE LIFE | 376 | $32K |
| Short-term disability | USABLE LIFE | 254 | $5K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 70 | $308K |
| Other(3 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 376 | $449K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 407 | — |
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.