| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $52K | $19K | $70K | 2.25% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $27K | — | $27K | 9.66% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | VISION SERVICE PLAN | $1K | — | $1K | 5.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DENTAL SERVICE OF MA, INC. EIN 04-6143185 CLAIMS ADMINISTRATOR | Other services; Claims processing; Contract Administrator Service code 12 | 465 MEDFORD STREET BOSTON, MA 021291454 | $26K |
| HILB GROUP OF NEW ENGLAND BROKER | Insurance agents and brokers Service code 22 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | $5K |
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 | 953 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 954 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 364 | $3.1M |
| Vision | VISION SERVICE PLAN | 163 | $17K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 953 | $279K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 953 | $279K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 953 | $279K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 364 | $3.1M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 953 | $279K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 953 | — |
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.