| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | BLUECROSSBLUESHIELD OF MASSACHUSETTS | $39K | $6K | $45K | 3.33% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | MONY LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 11.77% |
| INDIGO INSURANCE SERVICES3 | 446 MAIN STREET 5TH FLOOR WORCESTER, MA 01608 | MONY LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 7.00% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON STREET SUITE 400 BRAINTREE, MA 02184 | MONY LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 10.80% |
| INDIGO INSURANCE SERVICES3 | 446 MAIN STREET 5TH FLOOR WORCESTER, MA 01608 | MONY LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 7.00% |
| BAYSTATE BENEFIT SERVICES3 | 400 WASHINGTON ST SUITE 400 BRAINTREE, MA 02184 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | $1K | — | $1K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BAYSTATE BENEFIT SERVICES BROKER | Other commissions Service code 55 | 400 WASHINGTON ST. SUITE 400 BRAINTREE, MA 02184 | $0 |
| BLUE BENEFIT ADMIN OF MA CLAIMS PROCESSING | Claims processing Service code 12 | P O BOX 55917 BOSTON, MA 02205 | $0 |
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 | 214 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 217 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSSBLUESHIELD OF MASSACHUSETTS | 237 | $1.4M |
| Vision | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | 199 | $14K |
| Life insurance | MONY LIFE INSURANCE COMPANY OF AMERICA | 214 | $27K |
| Long-term disability | MONY LIFE INSURANCE COMPANY OF AMERICA | 214 | $30K |
| Other | MONY LIFE INSURANCE COMPANY OF AMERICA | 214 | $27K |
| 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."
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.