| 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. | $106K | $2K | $108K | 2.63% |
| THERESA PAGNINI3 | 550 LIBERTY STREET, SUITE 1308 BRAINTREE, MA 02184 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $9K | — | $9K | 5.92% |
| MJ INSURANCE3 Filed as: SHARON BOSTON AND VARIOUS AGENTS | 3400 LONGFIELD DRIVE SNELLVILLE, GA 30039 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $513 | $4K | 2.84% |
| LAURIE SEUBERT3 | 5835 POST ROAD EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $371 | $2K | 1.22% |
| JAMES R SMITH INSURANCE LTD3 | 5835 POST ROAD, SUITE 214 EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $567 | $2K | 1.21% |
| DONNA LEE JORDAN3 | 18 FORGE ROAD KINGSTON, MA 02364 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 0.73% |
| DAVID L FLEURY3 | 545 SOUTH MAIN STREET PROVIDENCE, RI 02903 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $646 | $291 | $937 | 0.64% |
| CHRISTOHER IHLEFELD3 | TWO TRENTON STREET, SUITE 2 PROVIDENCE, RI 02906 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $778 | $17 | $795 | 0.54% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | 500 BOYLSTON STREET, 4TH FLOOR BOSTON, MA 02116 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $21K | — | $21K | 14.67% |
| INDIGO INSURANCE SERVICES3 | 446 MAIN STREET, 5TH FLOOR WORCESTER, MA 01608 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $723 | — | $723 | 0.51% |
| THERESA PAGNINI3 Filed as: THERESA A. PAGNINI | 550 LIBERTY STREET, SUITE 1308 BRAINTREE, MA 02184 | THE PAUL REVERE LIFE INSURANCE COMPANY | $675 | — | $675 | 15.91% |
| DAVID J ROBERTS3 | 167 NEVINS ROAD HENRIETTA, NY 14467 | THE PAUL REVERE LIFE INSURANCE COMPANY | $360 | $11 | $371 | 8.74% |
| LAURIE SEUBERT3 | 5835 POST ROAD EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $122 | $18 | $140 | 3.30% |
| MJ INSURANCE3 Filed as: ETHAN EXELBERT AND VARIOUS AGENTS | 64 4TH AVENUE BROOKLYN, NY 11217 | THE PAUL REVERE LIFE INSURANCE COMPANY | $127 | — | $127 | 2.99% |
| AMY E COHEN3 Filed as: AMY SELAK | 95 LINWOOD AVENUE TONAWANDA, NY 14150 | THE PAUL REVERE LIFE INSURANCE COMPANY | $76 | $3 | $79 | 1.86% |
| JAMES R SMITH INSURANCE LTD3 | 5835 POST ROAD, SUITE 214 EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $70 | — | $70 | 1.65% |
| STEPHEN JOSEPH JOYCE3 | 70 SARGENT DRIVE AMHERST, NY 14226 | THE PAUL REVERE LIFE INSURANCE COMPANY | $32 | $21 | $53 | 1.25% |
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 | 375 | 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) | 375 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 636 | $4.1M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 636 | $4.1M |
| Life insurance | AMERICAN GENERAL LIFE INSURANCE COMPANY | 465 | $141K |
| Short-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 465 | $141K |
| Long-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 465 | $141K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 636 | $4.1M |
| Other(2 contracts, 2 carriers) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 465 | $145K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 636 | — |
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.