| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INSURANCE AGENCY | UNKNOWN BOSTON, MA 02210 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $17K | $0 | $17K | 1.69% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NE LLC | UNKNOWN BOSTON, MA 02210 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $14K | $2K | $16K | 1.59% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHENGLAND, LLC | 299 BALLARDVALE STREET WILMINGTON, MA 01887 | DENTAL SERVICE OF MASSACHUSETTS, INC. DBA DELTA DENTAL OF MA | $2K | $0 | $2K | 2.21% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX AGENCY INC. | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | DENTAL SERVICE OF MASSACHUSETTS, INC. DBA DELTA DENTAL OF MA | $1K | $0 | $1K | 1.60% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INSURANCE AGENCY INC. | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $2K | $7K | 13.48% |
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 | 100 | 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) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 157 | $1.0M |
| Dental | DENTAL SERVICE OF MASSACHUSETTS, INC. DBA DELTA DENTAL OF MA | 158 | $77K |
| Vision | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 157 | $1.0M |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 100 | $52K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 100 | $52K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 157 | $1.0M |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 100 | $52K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 158 | — |
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.