| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BAYSTATE FINANCIAL3 | 200 CLARENDON STREEET BOSTON, MA 02116 | METROPOLITAN LIFE INSURANCE COMPANY | $309 | $0 | $309 | 0.06% |
| SUZANNE M. HAZLETT3 | PO BOX 5378 KETCHUM, ID 83340 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $29K | $0 | $29K | 20.58% |
| ART JETTER AND COMPANY3 | 11305 CHICAGO CIRCLE OMAHA, NE 68154 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 1.50% |
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 | 791 | 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) | 791 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 956 | $8.9M |
| Dental | DELTA DENTAL OF OREGON | 791 | $652K |
| Vision | VISION SERVICE PLAN | 839 | $104K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 318 | $504K |
| Short-term disability(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 791 | $1.2M |
| Long-term disability | STANDARD INSURANCE COMPANY | 791 | $720K |
| Prescription drug(5 contracts, 5 carriers) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 956 | $8.9M |
| Other(3 contracts, 3 carriers) | STANDARD INSURANCE COMPANY | 791 | $869K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 956 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.