| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | HARVARD PILGRIM HEALTH CARE | $30K | $0 | $30K | 1.54% |
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | DELTA DENTAL OF MASSACHUSETTS | $2K | $0 | $2K | 1.33% |
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $12K | $0 | $12K | 12.00% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $71 | $71 | 0.07% |
| CHRISTINE GORDON3 Filed as: CHRISTINE A. OBERLANDER | 123 CARRINGTON LANE UXBRIDGE, MA 01569 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $47 | $3K | 6.63% |
| MICHAEL S OBERLANDER3 Filed as: MICHAEL S. OBERLANDER | 20 TALBOT DRIVE REHOBOTH, MA 02769 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $346 | $0 | $346 | 0.86% |
| DAVID A SILVIA3 Filed as: DAVID A. SILVIA | PO BOX 706 NORTH DIGHTON, MA 02764 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $220 | $0 | $220 | 0.54% |
| DAVID L FLEURY3 Filed as: DAVID L. FLEURY | 545 SOUTH MAIN STREET PROVIDENCE, RI 02903 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $104 | $0 | $104 | 0.26% |
| RICHARD HASKINS3 | 22 WEST STREET MILLBURY, MA 01527 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $77 | $24 | $101 | 0.25% |
| ASSUREDPARTNERS3 Filed as: BORISLOW INSURANCE | ONE GRIFFIN BROOK DRIVE METHUEN, MA 01844 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $143 | $3K | 14.68% |
| SIGNATOR INSURANCE AGENCY INC3 Filed as: SIGNATOR INSURANCE AGENCY, INC. | 197 CLARENDON STREET, UNIC C 8-8 BOSTON, MA 02116 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $631 | $0 | $631 | 3.62% |
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 | 196 | 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) | 198 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HARVARD PILGRIM HEALTH CARE | 317 | $1.9M |
| Dental | DELTA DENTAL OF MASSACHUSETTS | 346 | $142K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 196 | $97K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 196 | $97K |
| Long-term disability(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 196 | $115K |
| Prescription drug | HARVARD PILGRIM HEALTH CARE | 317 | $1.9M |
| Other(3 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 196 | $155K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 346 | — |
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.