| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $6K | $35K | $41K | 3.00% |
| BRENDA K COX3 Filed as: BRENDA K. COX | 1039 SPRINGWAY DRIVE SHELBYVILLE, IN 46176 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $0 | $4K | 10.99% |
| JEFFREY LUXENBERG3 | 307 LONGTREE LANE LOGANSPORT, IN 46947 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $391 | $47 | $438 | 1.16% |
| TODD J STRBIK3 Filed as: TODD J. STRBIK | 1727 NEMOKE TRAIL 4 HASLETT, MI 48840 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $70 | $0 | $70 | 0.18% |
| DIANA GILLESPIE3 | 353 EXCEL LANE MOGADORE, OH 44260 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $60 | $0 | $60 | 0.16% |
| MERRILL W SCHOENROCK3 Filed as: MERRILL W SCHOENROCK & OTHER AGENTS | 14721 BEACON BOULEVARD CARMEL, IN 46032 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $23 | $0 | $23 | 0.06% |
| RICHARD BEYLAND3 | 519 WINDSOR PARK DRIVE CENTERVILLE, OH 45459 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $20 | $0 | $20 | 0.05% |
| BEYLAND CONSULTANTS INC3 Filed as: BEYLAND CONSULTANTS, INC. | 519 WINDSOR PARK DRIVE CENTERVILLE, OH 45459 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $15 | $0 | $15 | 0.04% |
| THOMAS SCANLON3 | 121 ROLLING MEADOW DRIVE HOLLISTON, MA 01746 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $521 | $7K | 22.69% |
| ENROLLMENT SOLUTIONS LTD3 Filed as: ENROLLMENT SOLUTIONS LIMITED | 65 BURBANK ROAD SUTTON, MA 01590 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $567 | $577 | $1K | 3.71% |
| MICHAEL R ACKERMAN3 Filed as: MICHAEL R. ACKERMAN | 435 DEVON PARK DRIVE WAYNE, PA 19087 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $722 | $176 | $898 | 2.91% |
| MELISSA J LINDSEY3 Filed as: MELISSA J. LINDSEY | 152 HARRIS ROAD SMITHFIELD, RI 02917 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $480 | $0 | $480 | 1.56% |
| STEPHEN CORRIVEAU3 | 420 GRANGE ROAD NORTH SMITHFIELD, RI 02896 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $63 | $10 | $73 | 0.24% |
| FLEURY ENTERPRISES INC3 Filed as: FLEURY ENTERPRISES, INC. | 162 INDIAN POINT ROAD TIVERTON, RI 02878 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $20 | $0 | $20 | 0.06% |
| FALVEY BENEFIT ADVISORS INC3 Filed as: FALVEY BENEFIT ADVISORS, INC. | 2 LOCUST HULL DRIVE MENDON, MA 01756 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $20 | $0 | $20 | 0.06% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | ANTHEM LIFE INSURANCE COMPANY | $4K | $0 | $4K | 12.65% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.64% |
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 | 145 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 5 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 150 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 165 | $1.4M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 165 | $1.4M |
| Vision | VISION SERVICE PLAN | 93 | $19K |
| Life insurance(3 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 165 | $97K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 165 | $28K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 165 | $1.4M |
| Other | ANTHEM LIFE INSURANCE COMPANY | 165 | $28K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 165 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.