| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NEW ENGLAND, LLC | 299 BALLARDVALE STREET WILMINGTON, MA 01887 | TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. | $45K | $12K | $58K | 4.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NEW ENGLAND, LLC | 299 BALLARDVALE STREET WILMINGTON, MA 01887 | TUFTS INSURANCE COMPANY | $5K | $1K | $6K | 3.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NEW ENGLAND, LLC | 299 BALLARDVALE STREET WILMINGTON, MA 01887 | DELTA SERVICE OF MASSACHUSETTS, INC. DBA DELTA DENTAL OF MA | $6K | $963 | $7K | 5.20% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NEW ENGLAND, LLC | 100 CENTRAL STREET SUITE 210 HOLLISTON, MA 01746 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $12K | $0 | $12K | 11.72% |
| AXA ASSISTANCE, USA5 Filed as: AXA ASSITANCE, USA | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $43 | $0 | $43 | 0.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NEW ENGLAND, LLC | 300 BALLARDVALE STREET WILMINGTON, MA 01887 | VSP | $927 | $0 | $927 | 6.19% |
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 | 116 | 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) | 116 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. | 218 | $1.6M |
| Dental | DELTA SERVICE OF MASSACHUSETTS, INC. DBA DELTA DENTAL OF MA | 250 | $139K |
| Vision | VSP | 71 | $15K |
| Life insurance | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 116 | $100K |
| Short-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 116 | $100K |
| Long-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 116 | $100K |
| Prescription drug(2 contracts, 2 carriers) | TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. | 218 | $1.6M |
| Other | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 116 | $100K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 250 | — |
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.