| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT INSURANCE SERVICE | TWO PIERCE PLACE ITASCA, IL 60143 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS INC | $57K | $31K | $88K | 2.52% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES SOUTHEAS | 2245 TEXAS DRIVE SUITE 140 SUGAR LAND, TX 77479 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $15K | — | $15K | 15.00% |
| INDIGO INSURANCE SVC3 | 5TH FLOOR 446 MAIN STREET WORCESTER, MA 01608 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $7K | — | $7K | 7.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 116 HUNTINGTON AVE 10TH FLOOR BOSTON, MA 02116 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $263 | $2K | 18.47% |
| M FINANCIAL HOLDINGS INC3 Filed as: M FINANCIAL | 1125 NORTHWEST COUCH STREET SUITE 900 PORTLAND, OR 97209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $277 | $277 | 2.21% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $137 | $137 | $274 | 2.19% |
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 | 474 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 484 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS INC | 358 | $3.5M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS INC | 358 | $3.5M |
| Life insurance | AMERICAN GENERAL LIFE INSURANCE COMPANY | 582 | $98K |
| Short-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 582 | $98K |
| Long-term disability(2 contracts, 2 carriers) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 582 | $110K |
| Other(2 contracts, 2 carriers) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 582 | $110K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 582 | — |
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.