| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | UNKNOWN BRIARCLIFF MANOR, NY 10510 | HARVARD PILGRIM HEALTH CARE | $6K | $0 | $6K | 2.06% |
| USI INSURANCE SERVICES LLC3 | UNKNOWN STOUGHTON, MA 02072 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $5K | $0 | $5K | 3.75% |
| DIXON ASSOCIATES3 Filed as: DIXON ASSOCIATES INC. | PO BOX 1806 DUXBURY, MA 02331 | SUN LIFE ASSURANCE COMPANY OF CANADA | $9K | $0 | $9K | 8.45% |
| USI INSURANCE SERVICES LLC3 | PO BOX 1158 EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $21 | $2K | 8.45% |
| J KING INSURANCE INC3 Filed as: J. KING INSURANCE INC. | 5835 POST RAOD EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $666 | $141 | $807 | 3.71% |
| THERESA CATHERINE MACMILLAN3 | 650 EAST GREENWICH AVENUE WEST WARWICK, RI 02893 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $293 | $37 | $330 | 1.52% |
| LAURIE SEUBERT3 | 5835 POST ROAD EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $289 | $35 | $324 | 1.49% |
| 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 | $198 | $47 | $245 | 1.13% |
| DAVID L FLEURY3 Filed as: DAVID L. FLEURY | 545 SOUTH WATER STREET PROVIDENCE, RI 02903 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $135 | $35 | $170 | 0.78% |
| MJ INSURANCE3 Filed as: JASON R. SMITH AND VARIOUS AGENTS | 5835 POST ROAD EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $105 | $1 | $106 | 0.49% |
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 | 130 | 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) | 130 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HARVARD PILGRIM HEALTH CARE | 243 | $280K |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 268 | $140K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 130 | $102K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 130 | $102K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 130 | $102K |
| Prescription drug | HARVARD PILGRIM HEALTH CARE | 243 | $280K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 130 | $124K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 268 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.