| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | UNKNOWN WESTBOROUGH, MA 01581 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $22K | — | $22K | 1.83% |
| YOURPEOPLE, INC.3 Filed as: YOURPEOPLE INC DBA ZENEFITS | 303 2ND STREET, SUITE 401 SAN FRANCISCO, CA 94117 | DELTA DENTAL OF MASSACHUSETTS | $4K | — | $4K | 3.01% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62937 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF MASSACHUSETTS | $2K | — | $2K | 1.42% |
| JOHN VAN WIE3 | 170 HIGHWOOD CIRCLE OYSTER BAY, NY 11771 | DELTA DENTAL OF MASSACHUSETTS | $2K | — | $2K | 1.29% |
| JOHN VAN WIE3 | 261 MADISON AVENUE, 5TH FLOOR NEW YORK, NY 10016 | SYMETRA LIFE INSURANCE COMPANY | $7K | — | $7K | 8.70% |
| YOURPEOPLE, INC.3 Filed as: YOURPEOPLE INC DBA ZENEFITS | 303 2ND STREET SAN FRANCISCO, CA 94107 | SYMETRA LIFE INSURANCE COMPANY | $5K | — | $5K | 5.95% |
| JOHN VAN WIE3 | 11 HANOVER SQUARE, 2ND FLOOR NEW YORK, NY 10005 | SYMETRA LIFE INSURANCE COMPANY | $1K | — | $1K | 1.61% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 261 MADISON AVENUE, 5TH FLOOR NEW YORK, NY 11016 | SYMETRA LIFE INSURANCE COMPANY | — | $171 | $171 | 0.21% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62939 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE | $725 | — | $725 | 5.38% |
| YOURPEOPLE, INC.3 Filed as: YOURPEOPLE INC DBA ZENEFITS | 303 2ND STREET, SUITE 401 SAN FRANCISCO, CA 94107 | EYEMED VISION CARE | $444 | — | $444 | 3.29% |
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 | 105 | 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) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 216 | $1.2M |
| Dental | DELTA DENTAL OF MASSACHUSETTS | 216 | $134K |
| Vision | EYEMED VISION CARE | 161 | $13K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 116 | $80K |
| Short-term disability | SYMETRA LIFE INSURANCE COMPANY | 116 | $80K |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 116 | $80K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 216 | $1.2M |
| Other | SYMETRA LIFE INSURANCE COMPANY | 116 | $80K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 216 | — |
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.