| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EBS INSURANCE BROKERS3 Filed as: EBS INSURANCE BROKERS, INC. | 1 GATEWAY CTR STE 650 NEWTON, MA 02458 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $35K | $10K | $45K | 3.06% |
| EBS INSURANCE BROKERS3 Filed as: EBS INSURANCE BROKERS, INC. | 1 GATEWAY CENTER STE 650 NEWTON, MA 02458 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $9K | $855 | $10K | 8.68% |
| EBS INSURANCE BROKERS3 Filed as: EBS INSURANCE BROKERS, INC. | ONE GATEWAY CENTER SUITE 650 NEWTON, MA 02458 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $902 | — | $902 | 10.06% |
| GIS BENEFITS INC3 Filed as: GIS NATIONAL | 9500 KOGER AVE, STE 200 ST. PETERSBURG, FL 33702 | METLIFE LEGAL PLANS | $918 | — | $918 | 21.89% |
| EBS INSURANCE BROKERS3 | ONE GATEWAY CENTER, SUITE 650 NEWTON, MA 02458 | METLIFE LEGAL PLANS | $419 | — | $419 | 9.99% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | PO BOX 9201, BLDG I SUITE 100 AUSTIN, TX 78766 | METLIFE LEGAL PLANS | — | $213 | $213 | 5.08% |
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 | 113 | 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) | 113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 160 | $1.5M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 160 | $1.5M |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 132 | $9K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 113 | $116K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 113 | $116K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 113 | $116K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 160 | $1.5M |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 113 | $120K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 160 | — |
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.