| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PHILIP HEALY3 | C/O D AND S HOLDING 4 MAIN STREET PETERBOROUGH, NH 03458 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | — | $25K | $25K | 1.85% |
| PHILIP HEALY3 | C/O D AND S HOLDING 4 MAIN STREET PETERSBOROUGH, NH 03458 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | — | $5K | $5K | 0.85% |
| PHILIP HEALY3 | C/O D AND S HOLDING 4 MAIN STREET PETERBOROUGH, NH 03458 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | — | $2K | $2K | 1.92% |
| PHILIP HEALY3 | C/O D AND S HOLDING 4 MAIN STREET PETERBOROUGH, NH 03458 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | — | $286 | $286 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHSMART BENEFIT SOLUTIONS EIN 36-4099199 NONE | Contract Administrator Service code 13 | — | $107K |
| MEDCOST LLC EIN 56-1999192 NONE | Contract Administrator Service code 13 | — | $37K |
| HEALTHSMART PREFERRED EIN 06-1621470 NONE | Contract Administrator Service code 13 | — | $14K |
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 | 1,740 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 39 | Continuation coverage (COBRA, retiree health). |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 1,779 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED VISION CARE | 1,741 | $88K |
| Life insurance(2 contracts, 2 carriers) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,861 | $1.1M |
| Short-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 440 | $88K |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,871 | $1.4M |
| Other | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,022 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,871 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.