| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | PO BOX 632886 CINCINNATI, OH 45263 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $71K | $515 | $72K | 1.45% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | PO BOX 632886 CINCINNATI, OH 45263 | HARTFORD LIFE AND ACCIDENT | $14K | $245 | $14K | 10.17% |
| INDIGO INSURANCE SERVICES3 Filed as: INDIGO INSURANCE SERVICES, LLC | 446 MAIN STREET, 5TH FLOOR WORCESTER, MA 01608 | HARTFORD LIFE AND ACCIDENT | $0 | $10K | $10K | 7.00% |
| THERESA ANNE FERRIS3 | 5007 58TH TERRACE, SUITE E BRANDENTON, FL 34203 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $0 | $6K | 4.74% |
| MJ INSURANCE3 Filed as: DAVID L FLEURY AND VARIOUS AGENTS | 162 INDIAN POINT ROAD TIVERTON, RI 02878 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $129 | $2K | 1.77% |
| LAURIE SEUBERT3 | 5835 POST ROAD EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $339 | $1K | 1.11% |
| 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 | $287 | $1K | 1.03% |
| SHARON M BOSTON3 | 3400 LONGFIELD DRIVE SNELLVILLE, GA 30039 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $956 | $30 | $986 | 0.75% |
| DONNA LEE JORDAN3 | 18 FORGE ROAD KINGSTON, MA 02364 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $757 | $0 | $757 | 0.57% |
| DAVID ADAM BOAZ3 | 5804 POST ROAD, UNIT 2 EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $558 | $0 | $558 | 0.42% |
| THERESA ANNE FERRIS3 | 5007 58TH TERRACE, SUITE E BRANDENTON, FL 34203 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $724 | $0 | $724 | 6.94% |
| EMLYN MARSTELLER IV3 | 412 SUGARLAND MEADOW DRIVE HERNDON, VA 20170 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $264 | $30 | $294 | 2.82% |
| JASON SCZEPANIAK3 Filed as: JASON C SHAPIRO | 41 BRENTON STREET LITCHFIELD, NH 03052 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $165 | $32 | $197 | 1.89% |
| LAURIE SEUBERT3 | 5835 POST ROAD EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $137 | $49 | $186 | 1.78% |
| 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 | $112 | $36 | $148 | 1.42% |
| MJ INSURANCE3 Filed as: DURWOOD BOOTH JR AND VARIOUS AGENTS | 6231 HIGHAM DRIVE ALEXANDRIA, VA 22310 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $49 | $0 | $49 | 0.47% |
| DAVID L FLEURY3 | 162 INDIAN POINT ROAD TIVERTON, RI 02878 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $23 | $0 | $23 | 0.22% |
| THERESA ANNE FERRIS3 | 5007 58TH TERRACE, SUITE E BRANDENTON, FL 34203 | THE PAUL REVERE LIFE INSURANCE COMPANY | $113 | $0 | $113 | 3.60% |
| AMY E COHEN3 Filed as: AMY SELAK | 6901 WALMORE ROAD NIAGRA FALLS, NY 14304 | THE PAUL REVERE LIFE INSURANCE COMPANY | $33 | $0 | $33 | 1.05% |
| DAVID J ROBERTS3 | 167 NEVINS ROAD HENRIETTA, NY 14467 | THE PAUL REVERE LIFE INSURANCE COMPANY | $30 | $0 | $30 | 0.96% |
| LAURIE SEUBERT3 | 5835 POST ROAD EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $25 | $0 | $25 | 0.80% |
| 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 | $22 | $0 | $22 | 0.70% |
| DAVID L FLEURY3 | 162 INDIAN POINT ROAD TIVERTON, RI 02878 | THE PAUL REVERE LIFE INSURANCE COMPANY | $11 | $0 | $11 | 0.35% |
| MJ INSURANCE3 Filed as: STEPHEN JOYCE AND VARIOUS AGENTS | 70 SARGENT DRIVE AMHERST, NY 14226 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2 | $0 | $2 | 0.06% |
| THERESA ANNE FERRIS3 | 5007 58TH TERRACE, SUITE E BRANDENTON, FL 34203 | THE PAUL REVERE LIFE INSURANCE COMPANY | $787 | $0 | $787 | 29.95% |
| CHARLENE ALPAY3 | 606 WEST 116TH STREET NEW YORK, NY 10027 | THE PAUL REVERE LIFE INSURANCE COMPANY | $517 | $28 | $545 | 20.74% |
| LAURIE SEUBERT3 | 5835 POST ROAD EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $115 | $21 | $136 | 5.18% |
| 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 | $28 | $88 | 3.35% |
| MICHELLE DARTEE3 | 12 MOONSHADOW COURT KINNELON, NJ 07405 | THE PAUL REVERE LIFE INSURANCE COMPANY | $35 | $24 | $59 | 2.25% |
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 | 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. | 609 | $4.9M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 609 | $4.9M |
| Life insurance(5 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 466 | $290K |
| Short-term disability(4 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 116 | $148K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 466 | $142K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 609 | $4.9M |
| Other(4 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 466 | $287K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 609 | — |
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.