| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | $27K | $5K | $33K | 1.86% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | RELIANCE STANDARD | $12K | — | $12K | 7.74% |
| BENEFIT ADVISORS NETWORK LLC3 | 6830 COCHRAN ROAD SOLON, OH 44139 | RELIANCE STANDARD | $1K | — | $1K | 0.86% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | DELTA DENTAL | $6K | — | $6K | 4.47% |
| BAYSTATE BENEFIT SERVICES3 Filed as: BAYSTATE BENEFITS SERVICE | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | EYEMED | $2K | — | $2K | 9.22% |
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 | 237 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 44 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 281 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | 116 | $1.7M |
| Dental | DELTA DENTAL | 237 | $140K |
| Vision | EYEMED | 207 | $23K |
| Life insurance | RELIANCE STANDARD | 230 | $150K |
| Short-term disability | RELIANCE STANDARD | 230 | $150K |
| Long-term disability | RELIANCE STANDARD | 230 | $150K |
| Other | RELIANCE STANDARD | 230 | $150K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 237 | — |
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.