| 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 | $0 | $28K | $28K | 2.50% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $8K | $3K | $11K | 14.36% |
| THOMAS SCANLON3 | 121 ROLLING MEADOW DRIVE HOLLISTON, MA 01746 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $429 | $5K | 18.07% |
| ENROLLMENT SOLUTIONS LTD3 Filed as: ENROLLMENT SOLUTIONS LIMITED | 65 BURBANK ROAD SUTTON, MA 01590 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $471 | $428 | $899 | 2.96% |
| MICHAEL R ACKERMAN3 Filed as: MICHAEL R. ACKERMAN | 435 DEVON PARK DRIVE, SUITE 410 WAYNE, PA 19087 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $577 | $127 | $704 | 2.32% |
| MELISSA J LINDSEY3 Filed as: MELISSA J. LINDSEY | 152 HARRIS ROAD SMITHFIELD, RI 02917 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $370 | $0 | $370 | 1.22% |
| STEPHEN CORRIVEAU3 | 420 GRANGE ROAD NORTH SMITHFIELD, RI 02896 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $43 | $0 | $43 | 0.14% |
| FLEURY ENTERPRISES INC3 Filed as: FLEURY ENTERPRISES, INC. | 162 INDIAN POINT ROAD TIVERTON, RI 02878 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $17 | $0 | $17 | 0.06% |
| FALVEY BENEFIT ADVISORS INC3 Filed as: FALVEY BENEFIT ADVISORS, INC. | 2 LOCUST HILL DRIVE MENDON, MA 01756 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $7 | $0 | $7 | 0.02% |
| BRENDA K COX3 Filed as: BRENDA K. COX | 1039 SPRINGWAY DRIVE SHELBYVILLE, IN 46176 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 7.68% |
| TODD J STRBIK3 Filed as: TODD J. STRBIK | 1727 NEMOKE TRAIL, APARTMENT 4 HASLETT, MI 48840 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $532 | $49 | $581 | 2.33% |
| JEFFREY LUXENBERG3 | 307 LONGTREE LANE LOGANSPORT, IN 46947 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $196 | $1 | $197 | 0.79% |
| JEREMY SAMPSEL3 | 401 HALL STREET SW, SUITE 225 GRAND RAPIDS, MI 49503 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $73 | $101 | $174 | 0.70% |
| RICHARD BEYLAND3 | 519 WINDSOR PARK DRIVE CENTERVILLE, OH 45459 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $29 | $0 | $29 | 0.12% |
| DIANA GILLESPIE3 | 1122 BOULDER LANE KENT, OH 44240 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $27 | $0 | $27 | 0.11% |
| DAVID L SMELCER3 Filed as: DAVID L. SMELCER AND OTHER AGENTS | 3137 TOWNSHIP ROAD, SUITE 97 MCCOMB, OH 45858 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $10 | $0 | $10 | 0.04% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 6.15% |
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 | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 133 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 127 | $1.1M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 106 | $80K |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 106 | $80K |
| Life insurance(3 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 130 | $76K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 130 | $21K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 127 | $1.1M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 130 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 130 | — |
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.