| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | SUN LIFE ASSURANCE COMPANY OF CANADA | $12K | $4K | $16K | 8.06% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 S. 8TH ST STE 700 MINNEAPOLIS, MN 55402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $33 | $1K | 3.32% |
| J KING INSURANCE INC3 Filed as: J KING INSURANCE | 333 EAST MAIN ST EAST GREENWICH, RI 02818 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $769 | $43 | $812 | 2.13% |
| LAURIE SEUBERT3 | 333 EAST MAIN ST EAST GREENWICH, RI 02818 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $333 | $4 | $337 | 0.88% |
| THERESE CATHERINE MACMILLAN3 | 650 EAST GREENWICH AVE WEST WARWICK, RI 02893 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $156 | $2 | $158 | 0.41% |
| JASON HARTMAN3 Filed as: JASON C SHAPIRO | 41 BRENTON ST LITCHFIELD, NH 03052 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $148 | — | $148 | 0.39% |
| CLARICE R MIMS3 Filed as: CLARICE D MIMS | 172-90 HIGHLAND AVENUE JAMAICA ESTATES, NY 11432 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $141 | — | $141 | 0.37% |
| JAMES R SMITH INSURANCE LTD3 Filed as: JAMES R SMITH | 333 EAST MAIN ST EAST GREENWICH, RI 02818 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $105 | $18 | $123 | 0.32% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $3K | $0 | $3K | 10.83% |
| J KING INSURANCE INC3 Filed as: J KING INSURANCE INC. | 333 EAST MAIN ST EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $112 | — | $112 | 1.60% |
| MICHAEL C WALKER3 Filed as: MICHAEL MASSARELLI | 536 A BERLIN ST SOUTHINGTON, CT 06489 | THE PAUL REVERE LIFE INSURANCE COMPANY | $107 | — | $107 | 1.53% |
| LAURIE SEUBERT3 | 333 EAST MAIN ST EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $59 | — | $59 | 0.84% |
| CLARICE R MIMS3 | 172-90 HIGHLAND AVENUE NEW YORK, NY 10027 | THE PAUL REVERE LIFE INSURANCE COMPANY | $46 | — | $46 | 0.66% |
| MICHAEL R ACKERMAN3 | 435 DEVON PARK DR WAYNE, PA 19087 | THE PAUL REVERE LIFE INSURANCE COMPANY | $34 | — | $34 | 0.49% |
| JAMES R SMITH INSURANCE LTD3 | 333 MAIN ST EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $12 | — | $12 | 0.17% |
| ALEXANDER JEFFREY SEUBERT3 | 480 ATLANTIC AVE WARWICK, RI 02888 | THE PAUL REVERE LIFE INSURANCE COMPANY | $6 | — | $6 | 0.09% |
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 | 223 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 225 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 58 | $45K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 163 | $30K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 223 | $202K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 223 | $202K |
| Other(3 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 223 | $247K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 223 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.