| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | UNKNOWN WALTHAM, MA 02452 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $49K | $9K | $58K | 3.53% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62937 VIRGINIA BEACH, VA 23466 | EYE-MED | $2K | $0 | $2K | 9.16% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 5 GLASTONBURY BOULEVARD GLASTONBURY, CT 06033 | EYE-MED | $279 | $0 | $279 | 1.58% |
| INDIGO INSURANCE SERVICES3 | ATTENTION RICK CELLA 101 HUNTINGTON AVENUE BOSTON, MA 02199 | USABLE LIFE | $3K | $0 | $3K | 20.00% |
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 | 152 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 152 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 242 | $1.6M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 242 | $1.6M |
| Vision | EYE-MED | 206 | $18K |
| Life insurance | USABLE LIFE | 152 | $15K |
| Long-term disability | USABLE LIFE | 152 | $15K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 242 | $1.6M |
| Other | USABLE LIFE | 152 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 242 | — |
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.