| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 470 ATLANTIC AVENUE, 13TH FLOOR BOSTON, MA 02210 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $35K | $8K | $43K | 3.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2245 TEXAS DRIVE, SUITE 140 SUGAR LAND, TX 77479 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $4K | — | $4K | 13.11% |
| INDIGO INSURANCE SERVICES3 | 446 MAIN STREET, 5TH FLOOR WORCESTER, MA 01608 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $2K | — | $2K | 7.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 21ST FLOOR ITASCA, IL 60143 | MONY LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 6.31% |
| INDIGO INSURANCE SERVICES3 | 446 MAIN STREET, SUITE 5 WORCESTER, MA 01608 | MONY LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 4.24% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 470 ATLANTIC AVENUE, 13TH FLOOR BOSTON, MA 02210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 10.60% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $102 | $102 | 0.52% |
| C2 CENTRIC LLC3 | PO BOX 6824 GRAND RAPIDS, MI 49516 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $18 | $18 | 0.09% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 470 ATLANTIC AVENUE, 13TH FLOOR BOSTON, MA 02210 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $779 | $19 | $798 | 15.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 WEST GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $60 | $60 | 1.16% |
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 | 160 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 162 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 204 | $1.4M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 204 | $1.4M |
| Life insurance(3 contracts, 3 carriers) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 160 | $64K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 35 | $20K |
| Long-term disability(2 contracts, 2 carriers) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 160 | $59K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 204 | $1.4M |
| Other(3 contracts, 3 carriers) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 160 | $64K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 204 | — |
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.