| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX AGENCY, INC. | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | HARVARD PILGRIM HEALTH CARE | $21K | — | $21K | 1.44% |
| EBS INSURANCE BROKERS3 Filed as: EBS INSURANCE BROKERS, INC. | ONE GATEWAY CENTER SUITE 650 NEWTON, MA 02458 | HARVARD PILGRIM HEALTH CARE | $10K | — | $10K | 0.68% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX AGENCY INC. | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | HAVARD PILGRIM HEALTH CARE | $5K | — | $5K | 1.45% |
| EBS INSURANCE BROKERS3 Filed as: EBS INSURANCE BROKERS INC. | ONE GATEWAY CENTER SUITE 650 NEWTON, MA 02458 | HAVARD PILGRIM HEALTH CARE | $3K | — | $3K | 0.68% |
| PAYCHEX INSURANCE AGENCY, INC.3 | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $13K | $5K | $18K | 5.30% |
| EBS INSURANCE BROKERS3 Filed as: EBS INSURANCE BROKERS INC. | ONE GATEWAY CENTER SUITE 650 NEWTON, MA 02458 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $646 | $505 | $1K | 0.34% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX AGENCY INC. | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | DELTA DENTAL OF MASSACHUSETTS | $5K | — | $5K | 2.23% |
| EBS INSURANCE BROKERS3 Filed as: EBS INSURANCE BROKERS, INC. | ONE GATEWAY CENTER SUITE 650 NEWTON, MA 02458 | DELTA DENTAL OF MASSACHUSETTS | $2K | — | $2K | 0.88% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INSURANCE AGENCY | PO BOX 948 HENRIETTA, NY 14467 | VISION SERVICE PLAN | $1K | — | $1K | 4.92% |
| PAYCHEX INSURANCE AGENCY, INC.3 | 150 SAWGRASS DR. ROCHESTER, NY 14620 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $515 | $80 | $595 | 14.18% |
| EBS INSURANCE BROKERS3 Filed as: EBS INSURANCE BROKERS INC. | ONE GATEWAY CENTER SUITE 650 NEWTON, MA 02458 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $114 | $6 | $120 | 2.86% |
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 | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 175 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HARVARD PILGRIM HEALTH CARE | 340 | $1.8M |
| Dental | DELTA DENTAL OF MASSACHUSETTS | 430 | $237K |
| Vision | VISION SERVICE PLAN | 171 | $28K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 173 | $346K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 173 | $342K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 173 | $342K |
| Prescription drug(2 contracts, 2 carriers) | HARVARD PILGRIM HEALTH CARE | 340 | $1.8M |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 173 | $346K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 430 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.