| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES | 340 MADISON AVENUE 21ST FLOOR NEW YORK, NY 10173 | FALLON HEALTH | $33K | $0 | $33K | 1.87% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES LLC | 340 MADISON AVENUE 21ST FLOOR NEW YORK, NY 10173 | DENTAL SERVICE OF MASSACHUSETTS, INC. D/B/A DELTA DENTAL | $5K | $0 | $5K | 4.22% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES | 340 MADISON AVENUE 21ST FLOOR NEW YORK, NY 10173 | FALLON HEALTH & LIFE ASSURANCE COMPANY | $1K | $0 | $1K | 1.85% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES | 340 MADISON AVENUE 21ST FLOOR NEW YORK, NY 10173 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $3K | $9K | 20.48% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ULTRABENEFITS, INC. EIN 04-3525752 | Contract Administrator Service code 13 | 22 ELM STREET SUITE 110 WORCESTER, MA 01608 | $9K |
| TOTAL ADMINISTRATIVE SERVICES CORP EIN 39-1561025 | Contract Administrator Service code 13 | 2302 INTERNATIONAL LANE MADISON, WI 53704 | $6K |
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 | 210 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 212 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | FALLON HEALTH | 247 | $1.8M |
| Dental | DENTAL SERVICE OF MASSACHUSETTS, INC. D/B/A DELTA DENTAL | 287 | $122K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 210 | $43K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 210 | $43K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 210 | $43K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 287 | — |
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.