| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EBS INSURANCE BROKERS3 Filed as: EBS INSURANCE BROKERS INC | 1 GATEWAY CTR STE 650 NEWTON, MA 02458 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $106K | — | $106K | 1.72% |
| LUCIER, MARK B3 Filed as: LUCIER, MARK | 2 RICE SPRING LN WAYLAND, MA 01778 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $54K | — | $54K | 0.88% |
| THE CLAUSEN FINANCIAL GROUP3 Filed as: CLAUSEN, DAVID A | 52 PICKERING ST NEEDHAM, MA 02492 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $0 | $39K | $39K | 0.63% |
| EBS INSURANCE BROKERS3 Filed as: EBS INSURANCE BROKERS INC | 1 GATEWAY CTR STE 650 NEWTON, MA 024582834 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | — | $6K | 1.69% |
| MARK LUCIER3 | 2 RICE SPRING LN WAYLAND, MA 017783510 | METROPOLITAN LIFE INSURANCE COMPANY | $431 | — | $431 | 0.11% |
| EBS INSURANCE BROKERS3 Filed as: EBS INSURANCE BROKERS INC | SUITE 650 ONE GATEWAY CENTER NEWTON, MA 02458 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $12K | — | $12K | 3.49% |
| MARK LUCIER3 | C/O CLAUSEN FINANCIAL GROUP 2 RICE SPRING LANE WAYLAND, MA 017783510 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 0.39% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $148 | $148 | 0.04% |
| EBS INSURANCE BROKERS3 Filed as: EBS INSURANCE BROKERS INC | 1 GATEWAY CTR STE 650 NEWTON, MA 02458 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $4K | — | $4K | 8.07% |
| MARK B. LUCIER3 | 2 RICE SPRING LANE WAYLAND, MA 01778 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $582 | — | $582 | 1.28% |
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 | 604 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 607 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 1,254 | $6.1M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 1,670 | $383K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 1,212 | $46K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 742 | $350K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 742 | $350K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 742 | $350K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 742 | $350K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,670 | — |
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.