| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | UNKNOWN BRIARCLIFF MANOR, NY 10510 | HARVARD PILGRIM HEALTH CARE | $29K | $0 | $29K | 2.00% |
| USI INSURANCE SERVICES LLC3 | UNKNOWN STOUGHTON, MA 02072 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $5K | $1K | $6K | 4.34% |
| DIXON ASSOCIATES3 Filed as: DIXON ASSOCIATES INC. | PO BOX 1806 DUXBURY, MA 02331 | SUN LIFE ASSURANCE COMPANY OF CANADA | $9K | $0 | $9K | 8.54% |
| USI INSURANCE SERVICES LLC3 | PO BOX 1158 EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $48 | $2K | 7.31% |
| J KING INSURANCE INC3 Filed as: J. KING INSURANCE INC. | 5835 POST ROAD EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $718 | $458 | $1K | 5.19% |
| LAURIE SEUBERT3 | 5835 POST RAOD EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $303 | $66 | $369 | 1.63% |
| JAMES R SMITH INSURANCE LTD3 Filed as: JAMES R. SMITH INSURANCE LTD | 5835 POST ROAD, SUITE 214 EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $215 | $133 | $348 | 1.53% |
| MJ INSURANCE3 Filed as: DAVID L. FLEURY AND VARIOUS AGENTS | 545 SOUTH MAIN STREET PROVIDENCE, RI 02903 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $271 | $61 | $332 | 1.46% |
| THERESA CATHERINE MACMILLAN3 Filed as: THERESA CATHERNE MACMILLAN | 650 EAST GREENWICH AVENUE WEST WARWICK, RI 02893 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $281 | $18 | $299 | 1.32% |
| SHARON R. SMITH3 Filed as: SHARON BERUBE | 755 BLACK PLAIN ROAD NORTH SMITHFIELD, RI 02896 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $165 | $40 | $205 | 0.90% |
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 | 141 | 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) | 141 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HARVARD PILGRIM HEALTH CARE | 247 | $1.4M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 309 | $148K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 141 | $100K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 141 | $100K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 141 | $100K |
| Prescription drug | HARVARD PILGRIM HEALTH CARE | 247 | $1.4M |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 141 | $122K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 309 | — |
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.