| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES | 50 BRAINTREE HILL OFFICE PARK BRAINTREE, MA 02184 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | $0 | $4K | 4.81% |
| BALDWIN KRYSTYN SHERMAN PARTNERS3 | 410 UNIVERSITY AVE WESTWOOD, MA 02090 | PRINCIPAL LIFE INSURANCE COMPANY | $955 | $0 | $955 | 1.28% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTH PLANS, INC ADMIN | Claims processing Service code 12 | 1500 WEST PARK DR #330 WESTBOROUGH, MA 01581 | $48K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $2K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $852 |
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 | 121 | 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) | 121 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 150 | $75K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 150 | $75K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 150 | $75K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 29 | $294K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 150 | — |
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.