| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROWN & BROWN INSURANCE SERVICES3 | — | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS INC | $38K | $6K | $45K | 2.47% |
| BROWN & BROWN INSURANCE SERVICES3 | 144 TURNPIKE RD. SUITE 330 SOUTHBOROUGH, MA 01772 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 11.71% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN OF FLORIDA | PO BOX 745834 ATLANTA, GA 30374 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 3.16% |
| IMG3 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $23 | $23 | 0.03% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN INSURANCE SERVICES, I | 901 MARQUETTE AVE STE 1800 MINNEAPOLIS, MN 55402 | VISION SERVICE PLAN | $809 | — | $809 | 7.92% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 901 MARQUETTE AVE STE 1800 MINNEAPOLIS, MN 55402 | VISION SERVICE PLAN | -$5 | — | -$5 | -0.05% |
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 | 82 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 84 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS INC | 171 | $1.8M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS INC | 171 | $1.8M |
| Vision | VISION SERVICE PLAN | 72 | $10K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 82 | $79K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 82 | $79K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 82 | $79K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS INC | 171 | $1.8M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 82 | $79K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 171 | — |
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.