| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | 318 BEAR HILL ROAD WALTHAM, MA 02451 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $89K | $23K | $113K | 3.14% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS. SVCS., INC. | 951 YAMATO ROAD, SUITE 200W BOCA RATON, TN 37027 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $19K | — | $19K | 5.23% |
| BULFINCH GROUP INSURANCE AGENCY3 | 160 GOULD STREET, SUITE 310 NEEDHAM, MA 02494 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $126 | — | $126 | 0.03% |
| THERESA PAGNINI3 | 110 CARLETON STREET WHITEMAN, MA 02382 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $10K | $106 | $10K | 9.22% |
| MJ INSURANCE3 Filed as: GAIL D. GOODEN AND VARIOUS AGENTS | 1224 STONE BLUFF DRIVE FENTON, MO 63026 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $735 | $5K | 4.56% |
| 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 | $1K | $2K | $3K | 2.58% |
| LAURIE SEUBERT3 | 5835 POST ROAD EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $733 | $2K | 2.15% |
| CHRISTOPHER IHLEFELD3 Filed as: CHRISTOPHER IHEFELD | 104 JOHN STREET PROVIDENCE, RI 02906 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $64 | $2K | 2.04% |
| DAVID L FLEURY3 Filed as: DAVID L. FLEURY | 545 SOUTH MAIN STREET PROVIDENCE, RI 02903 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $706 | $477 | $1K | 1.05% |
| DONNA LEE JORDAN3 Filed as: DONNA LEE JORDON | 18 FORGE ROAD KINSTON, MA 02364 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 1.02% |
| THERESA PAGNINI3 Filed as: THERESA A. PAGNINI | 550 LIBERTY STREET, SUITE 1308 BRAINTREE, MA 02184 | THE PAUL REVERE LIFE INSURANCE COMPANY | $452 | $8 | $460 | 16.70% |
| ETHEN EXELBERT3 | 64 4TH AVENUE BROOKLYN, NY 11217 | THE PAUL REVERE LIFE INSURANCE COMPANY | $241 | — | $241 | 8.75% |
| AMY E COHEN3 Filed as: AMY SELAK | 48 DALE DRIVE NORTH TONAWANDA, NY 14120 | THE PAUL REVERE LIFE INSURANCE COMPANY | $193 | $3 | $196 | 7.11% |
| LAURIE SEUBERT3 | 5835 POST ROAD EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $109 | $36 | $145 | 5.26% |
| MJ INSURANCE3 Filed as: STEVEN J. JOYCE AND VARIOUS AGENTS | 70 SARGENT DRIVE AMHERST, NY 14226 | THE PAUL REVERE LIFE INSURANCE COMPANY | $68 | $26 | $94 | 3.41% |
| HOWARD HOROWITZ3 Filed as: HOWARD P. DILEMA | 55 BROADWAY NEW YORK, NY 10006 | THE PAUL REVERE LIFE INSURANCE COMPANY | $34 | $32 | $66 | 2.40% |
| JAMES R SMITH INSURANCE LTD3 Filed as: JAMES R. SMITH INSURANCE, LTD | 5835 POST ROAD, SUITE 214 EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $60 | — | $60 | 2.18% |
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 | 457 | 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) | 457 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 635 | $3.6M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 461 | $361K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 461 | $361K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 461 | $361K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 635 | $3.6M |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 461 | $363K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 635 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.