| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INDIGO INSURANCE SERVICES3 Filed as: INDIGO INSURANCE SERVICES LLC | 446 MAIN ST 5TH FL WORCESTER, MA 01608 | SYMETRA LIFE INSURANCE COMPANY | $66K | — | $66K | 4.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | SYMETRA LIFE INSURANCE COMPANY | $35K | — | $35K | 2.61% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | HUB INTERNAQTIONAL MIDWEST RIVERSIDE, CA 925162158 | EYEMED VISION CARE | $12K | — | $12K | 5.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | EYEMED VISION CARE | $8K | — | $8K | 3.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | HUB INTERNATIONAL MIDWEST LIMITED RIVERSIDE, CA 925162158 | EYEMED VISION CARE | $70 | — | $70 | 5.94% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | EYEMED VISION CARE | $46 | — | $46 | 3.90% |
| BAYSTATE BENEFIT SERVICES3 Filed as: BAYSTATE BENEFIT SERVICES, INC. | 400 WASHINGTON ST., SUITE 400 BRAINTREE, MA 02184 | BAYSTATE BENEFIT SERVICES, INC. | — | $92K | $92K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MA EIN 04-1045815 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $179K |
| RXBENEFITS, INC. EIN 63-1157085 CLAIMS PROCESSING | Claims processing Service code 12 | — | $23K |
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 | 1,431 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,440 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNIVERSITY HEALTH ALLIANCE | 13 | $76K |
| Vision(3 contracts, 2 carriers) | EYEMED VISION CARE | 3,388 | $276K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 1,985 | $1.3M |
| Short-term disability(3 contracts) | SYMETRA LIFE INSURANCE COMPANY | 1,985 | $1.4M |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 1,985 | $1.3M |
| Prescription drug | UNIVERSITY HEALTH ALLIANCE | 13 | $76K |
| Other(2 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 1,985 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,388 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.