| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT INSURANCE SERVICE | 50 BRAINTREE HILL PARK #310 BRAINTREE, MA 02184 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $28K | — | $28K | 1.56% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF MA LLC | 980 WASHINGTON STREET SUITE 325 DEDHAM, MA 02026 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $7K | $3K | $11K | 0.59% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT INSURANCE SERVICE | 50 BRAINTREE HILL PARK #310 BRAINTREE, MA 02184 | BLUE CROSS BLUE SHIELD OF MASSACAHUSETTS, INC. | $4K | — | $4K | 3.70% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF MA LLC | 980 WASHINGTON STREET SUITE 325 DEDHAM, MA 02026 | BLUE CROSS BLUE SHIELD OF MASSACAHUSETTS, INC. | $469 | — | $469 | 0.43% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLD ROAD 5TH FLOOR ROLLING MEADOWS, IL 60008 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4K | — | $4K | 5.11% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF MASSACHUSETTS, INC | 155 FEDERAL STREET SUITE 1500 BOSTON, MA 02110 | SUN LIFE ASSURANCE COMPANY OF CANADA | $207 | — | $207 | 0.30% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD 5TH FLOOR ROLLING MEADOWS, IL 60008 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 10.43% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF MASSACHUSETTS, LLC | 155 FEDERAL STREET SUITE 1500 BOSTON, MA 02110 | SUN LIFE ASSURANCE COMPANY OF CANADA | $221 | — | $221 | 0.67% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD 5TH FLOOR ROLLING MEADOWS, IL 60008 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 6.86% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF MASSACHUSETTS, LLC | 155 FEDERAL STREET SUITE 1500 BOSTON, MA 02110 | SUN LIFE ASSURANCE COMPANY OF CANADA | $188 | — | $188 | 0.69% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SOLUTIONS | 470 ATLANTIC AVE BOSTON, MA 02210 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE COMPA | $1K | — | $1K | 8.45% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF MA | PO BOX 745949 ATLANTA, GA 30374 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE COMPA | $103 | — | $103 | 0.74% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD 5TH FLOOR ROLLING MEADOWS, IL 60008 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 8.63% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF MASSACHUSETTS, LLC | 155 FEDERAL STREET SUITE 1500 BOSTON, MA 02110 | SUN LIFE ASSURANCE COMPANY OF CANADA | $119 | — | $119 | 1.01% |
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 | 175 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 178 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 55 | $1.8M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACAHUSETTS, INC. | 57 | $108K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE COMPA | 101 | $14K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 175 | $27K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 175 | $12K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 175 | $33K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 55 | $1.8M |
| Other(2 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 175 | $97K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 175 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.