| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COSTELLO BENEFITS GROUP3 | — | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $19K | $2K | $21K | 3.18% |
| COSTELLO BENEFITS GROUP3 Filed as: COSTELLO BENEFITS GROUP INSURANCE | 800 WEST CUMMINGS PARK SUITE 4000 WOBURN, MA 01801 | ADVANTAGE HEALTH SOLUTIONS, INC. | $7K | — | $7K | 3.39% |
| WESOLOWSKI INSURANCE AGENCY3 | 216 SOUTH TAYLOR STREET SOUTH BEND, IN 46601 | ADVANTAGE HEALTH SOLUTIONS, INC. | $3K | — | $3K | 1.61% |
| COSTELLO BENEFITS GROUP3 Filed as: COSTELLO BENEFITS GROUP INSURANCE | 800 WEST CUMMINGS PARK SUITE 6900 WOBURN, MA 01801 | HEALTHAMERICA OF PENNSYLVANIA, INC. | $5K | — | $5K | 3.03% |
| COSTELLO BENEFITS GROUP3 | 800 WEST CUMMINGS PARK SUITE 6900 WOBURN, MA 01801 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $4K | — | $4K | 7.47% |
| INDIGO INSURANCE SERVICES3 | 446 MAIN STREET FIFTH FLOOR WORCESTER, MA 01608 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $3K | — | $3K | 7.00% |
| SMALL BUSINESS INSURANCE AGENCY3 Filed as: SMALL BUSINESS INSURANCE | 542 MAIN STREET WORCESTER, MA 01608 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $1K | — | $1K | 2.72% |
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 | 138 | 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) | 138 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 79 | $1.0M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 79 | $664K |
| Life insurance | AMERICAN GENERAL LIFE INSURANCE COMPANY | 138 | $48K |
| Short-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 138 | $48K |
| Other | AMERICAN GENERAL LIFE INSURANCE COMPANY | 138 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 138 | — |
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.