| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 116 HUNTINGTON AVE BOSTON, MA 02116 | AETNA LIFE INSURANCE CO. | $71K | — | $71K | 2.26% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS NORTHEAST LLC | 123 MAIN ST 14TH FLOOR WHITE PLAINS, NY 10601 | AETNA LIFE INSURANCE CO. | $25K | — | $25K | 0.81% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J GALLAGHER - IRVINE | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | KAISER FOUNDATION HEALTH PLAN INC | $23K | — | $23K | 1.86% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS NORTHEAST, LLC | 123 MAIN ST 14TH FLOOR WHITE PLAINS, NY 10601 | KAISER FOUNDATION HEALTH PLAN INC | $11K | — | $11K | 0.91% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J GALLAGHER - IRVINE | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | KAISER FOUNDATION HEALTH PLAN INC | $22K | — | $22K | 9.53% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS NORTHEAST, LLC | 123 MAIN ST 14TH FLOOR WHITE PLAINS, NY 10601 | KAISER FOUNDATION HEALTH PLAN INC | $2K | — | $2K | 0.92% |
| MARSH & MCLENNAN AGENCY LLC3 | 101 HUNTINGTON AVE STE 401 BOSTON, MA 02199 | KAISER FOUNDATION HEALTH PLAN INC | -$17K | — | -$17K | -7.31% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 470 ATLANTIC STREET BOSTON, MA 02210 | VISION SERVICE PLAN | $1K | — | $1K | 2.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $7K | — | $7K | 20.72% |
| MARSH & MCLENNAN AGENCY LLC3 | 101 HUNTINGTON AVENUE SUITE 401 BOSTON, MA 02199 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $755 | — | $755 | 2.20% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 2850 GULF ROAD ROLLING MEADOWS, IL 60008 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | — | $410 | $410 | 1.19% |
| JULIE GERSHON3 | 7 CAPOZZI CIRCLE WOBURN, MA 01801 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $1K | — | $1K | 11.31% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $1K | — | $1K | 9.52% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF MA EIN 04-6143185 DENTAL ADMINISTRATION | Contract Administrator; Claims processing Service code 12 | — | $365K |
| PLANSOURCE EIN 55-0800751 NONE | Contract Administrator; Claims processing Service code 12 | — | $26K |
| ASSUREDPARTNERS NORTHEAST, LLC EIN 45-3443572 NONE | Contract Administrator; Claims processing Service code 12 | — | $0 |
| MARSH & MCLENNAN AGENCY LLC EIN 26-3237576 NONE | Claims processing; Contract Administrator Service code 12 | — | $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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 397 | $4.6M |
| Vision | VISION SERVICE PLAN | 239 | $48K |
| Life insurance | AETNA LIFE INSURANCE CO. | 397 | $3.1M |
| Short-term disability | AETNA LIFE INSURANCE CO. | 397 | $3.1M |
| Long-term disability | AETNA LIFE INSURANCE CO. | 397 | $3.1M |
| Prescription drug(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 174 | $1.5M |
| Other(3 contracts, 3 carriers) | AETNA LIFE INSURANCE CO. | 397 | $3.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 397 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.