| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UNKNOWN3 | UNKNOWN NEWTON, MA 02459 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $69K | $0 | $69K | 1.47% |
| INDIGO INSURANCE SERVICES3 Filed as: INDIGO INSURANCE SERVICES, LLC | 446 MAIN STREET, 5TH FLOOR WORCESTER, MA 01608 | HARTFORD LIFE AND ACCIDENT | $0 | $10K | $10K | 7.41% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | PO BOX 632886 CINCINNATI, OH 45263 | HARTFORD LIFE AND ACCIDENT | $8K | $0 | $8K | 5.92% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | 700 WEST 47TH STREET, SUITE 1100 KANSAS CITY, MO 64112 | HARTFORD LIFE AND ACCIDENT | $6K | $0 | $6K | 4.08% |
| THERESA ANNE FERRIS3 | 550 LIBERTY STREET, UNIT 1308 BRAINTREE, MA 02184 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $10K | $0 | $10K | 10.00% |
| MJ INSURANCE3 Filed as: BEIYANIL E PENA AND VARIOUS AGENTS | 97 LEE STREET PAWTUCKET, RI 02861 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $364 | $3K | 3.39% |
| JAMES R SMITH INSURANCE LTD3 | 5835 POST ROAD, SUITE 214 EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $478 | $2K | 1.81% |
| LAURIE SEUBERT3 Filed as: LAURIE SUEBERT | 5835 POST ROAD EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $289 | $2K | 1.80% |
| SHARON M BOSTON3 | 3400 LONGFIELD DRIVE SNELLVILLE, GA 30039 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $175 | $1K | 1.49% |
| STEPHANIE DANGELO3 | 45 HOPKINS AVENUE EAST GREEENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $34 | $1K | 1.07% |
| DONNA LEE JORDAN3 | 18 FORGE ROAD KINGSTON, MA 02364 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $914 | $0 | $914 | 0.94% |
| THERESA ANNE FERRIS3 | 550 LIBERTY STREET, UNIT 1308 BRAINTREE, MA 02184 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 14.97% |
| EMLYN MARSTELLER IV3 Filed as: EMLYN H MARSTELLER IV | 412 SUGARLAND MEADOW DRIVE HERNDON, VA 20170 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $541 | $59 | $600 | 4.25% |
| LAURIE SEUBERT3 | 5835 POST ROAD EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $288 | $60 | $348 | 2.46% |
| JAMES R SMITH INSURANCE LTD3 | 5835 POST ROAD, SUITE 214 EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $230 | $88 | $318 | 2.25% |
| MJ INSURANCE3 Filed as: DAVID L FLEURY AND VARIOUS AGENTS | 545 SOUTH WATER STREET PROVIDENCE, RI 02903 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $216 | $33 | $249 | 1.76% |
| JASON SCZEPANIAK3 Filed as: JASON C SHAPIRO | 41 BRENTON STREET LITCHFIELD, NH 03052 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $170 | $27 | $197 | 1.40% |
| STEPHANIE DANGELO3 | 45 HOPKINS AVENUE EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $74 | $2 | $76 | 0.54% |
| THERESA PAGNINI3 Filed as: THERESA ANN FERRIS | 550 LIBERTY STREET, UNIT 1308 BRAINTREE, MA 02184 | THE PAUL REVERE LIFE INSURANCE COMPANY | $341 | $0 | $341 | 11.67% |
| DAVID J ROBERTS3 | 1674 NEVINS ROAD HENRIETTA, NY 14467 | THE PAUL REVERE LIFE INSURANCE COMPANY | $189 | $17 | $206 | 7.05% |
| LAURIE SEUBERT3 | 5835 POST ROAD EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $64 | $4 | $68 | 2.33% |
| JAMES SMITH3 Filed as: JAMES SMITH INSURANCE LTD | 5835 POST ROAD, SUITE 214 EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $45 | $6 | $51 | 1.75% |
| AMY E COHEN3 Filed as: AMY SELAK | 95 LINWOOD AVENUE TONAWANDA, NY 14150 | THE PAUL REVERE LIFE INSURANCE COMPANY | $36 | $0 | $36 | 1.23% |
| MJ INSURANCE3 Filed as: STEVEN JOYCE AND VARIOUS AGENTS | 70 SARGENT DRIVE AMHERST, NY 14226 | THE PAUL REVERE LIFE INSURANCE COMPANY | $23 | $5 | $28 | 0.96% |
| DAVID L FLEURY3 | 545 SOUTH WATER STREET PROVIDENCE, RI 02903 | THE PAUL REVERE LIFE INSURANCE COMPANY | $20 | $0 | $20 | 0.68% |
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 | 483 | 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) | 483 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 646 | $4.7M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 646 | $4.7M |
| Life insurance(4 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 483 | $251K |
| Short-term disability(3 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 126 | $114K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 483 | $137K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 646 | $4.7M |
| Other(4 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 483 | $251K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 646 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.