| 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. | $5K | — | $5K | 6.71% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 12.63% |
| INDIGO INSURANCE SERVICES3 | 401 PARK DR. BOSTON, MA 02215 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | — | $3K | $3K | 5.28% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $1K | — | $1K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ULTRABENEFITS, INC. EIN 39-0819344 THIRD PARTY ADMIN(TPA) | Claims processing; Contract Administrator Service code 12 | — | $42K |
| HILB GROUP OF NEW ENGLAND BROKER | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | $41K |
| CIGNA CLAIMS PROCESSING | Claims processing Service code 12 | 900 COTTAGE GROVE RD. BLOOMFIELD, CT 06002 | $18K |
| RIGHTWAY CLAIMS PROCESSING | Claims processing Service code 12 | 2 GANSEVOORT ST., STE. 701 NEW YORK, NY 10014 | $7K |
| TELADOC CLAIMS PROCESSING | Claims processing Service code 12 | 2 MANHATTANVILLE RD. PURCHASE, NY 10577 | $2K |
| PHIA CONSULTING | Claims processing; Consulting (general) Service code 12 | 40 PEQUOT WAY CANTON, MA 02021 | $1K |
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 | 168 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 168 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 158 | $80K |
| Vision | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 209 | $13K |
| Life insurance | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 168 | $49K |
| Short-term disability | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 168 | $49K |
| Long-term disability | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 168 | $49K |
| Stop-loss / reinsurancereinsurance | COVERYS | 106 | $213K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 209 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.