| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MR DAVID PANKRATZ3 Filed as: MR. DAVID PANKRATZ | PO BOX 385 REHOBOTH, MA 02769 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $35 | — | $35 | — |
| MR KEITH MACWHORTER3 | PO BOX 323 SWANSEA, MA 02777 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $35 | — | $35 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MASSACHUSETTS MUTUAL LIFE INS. CO. EIN 04-1590850 CONTRACT ADMINISTRATOR | Recordkeeping fees; Sub-transfer agency fees; Soft dollars commissions; Investment management fees paid indirectly by plan; Other investment fees and expenses Service code 52 | — | $24K |
| DREYFUS EIN 90-0342299 INVESTMENT PROVIDER | Investment management fees paid indirectly by plan Service code 52 | — | $0 |
| OPPENHEIMER EIN 13-6977079 INVESTMENT PROVIDER | Investment management fees paid indirectly by plan Service code 52 | — | $0 |
| T. ROWE PRICE EIN 52-2264646 INVESTMENT PROVIDER | Investment management fees paid indirectly by plan Service code 52 | — | $0 |
| THORNBURG EIN 85-0451747 INVESTMENT PROVIDER | Investment management fees paid indirectly by plan Service code 52 | — | $0 |
| WELLS FARGO EIN 41-0449260 INVESTMENT PROVIDER | Investment management fees paid indirectly by plan Service code 52 | — | $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 | 162 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 5 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 168 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AMERICAN GENERAL LIFE INSURANCE COMPANY | 8 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 8 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.