| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 116 HUNTINGTON AVENUE BOSTON, MA 02116 | HARVARD PILGRIM HEALTH CARE | $33K | — | $33K | 1.66% |
| EASTERN BENEFITS GROUP3 | PO BOX 4000 WAKEFIELD, MA 01880 | HARVARD PILGRIM HEALTH CARE | $21K | — | $21K | 1.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 116 HUNTINGTON AVENUE BOSTON, MA 02116 | DENTAL SERVICE OF MASSACHUSETTS, INC. DBA DELTA DENTAL OF MA | $3K | — | $3K | 1.68% |
| EASTERN INSURANCE GROUP LLC3 | PO BOX 4000 WAKEFIELD, MA 01880 | DENTAL SERVICE OF MASSACHUSETTS, INC. DBA DELTA DENTAL OF MA | $3K | — | $3K | 1.67% |
| EASTERN INSURANCE GROUP LLC3 | 233 WEST CENTRAL STREET NATICK, MA 01760 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | — | $7K | 9.69% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $960 | — | $960 | 1.42% |
| EASTERN BENEFITS GROUP3 | PO BOX 4 WAKEFIELD, MA 01880 | EYEMED | $481 | — | $481 | 5.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 116 HUNTINGTON AVENUE, 10TH FLOOR BOSTON, MA 02116 | EYEMED | $375 | — | $375 | 3.91% |
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 | 163 | 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) | 163 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HARVARD PILGRIM HEALTH CARE | 380 | $2.0M |
| Dental | DENTAL SERVICE OF MASSACHUSETTS, INC. DBA DELTA DENTAL OF MA | 358 | $171K |
| Vision | EYEMED | 207 | $10K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 163 | $67K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 163 | $67K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 163 | $67K |
| Prescription drug | HARVARD PILGRIM HEALTH CARE | 380 | $2.0M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 163 | $67K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 380 | — |
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.