| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | 500 BOYLSTON STREET, 4TH FLOOR BOSTON, MA 02116 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $74K | $14K | $87K | 1.69% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | PO BOX 632886 CINCINNATI, OH 45263 | HARTFORD LIFE AND ACCIDENT | $14K | $446 | $15K | 10.32% |
| 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 EAST BRADENTON, FL 34203 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $8K | $0 | $8K | 6.32% |
| STEPHANIE DANGELO3 Filed as: STEPHANIE DANGELO AND OTHER AGENTS | 45 HOPKINS AVENUE EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $109 | $2K | 1.93% |
| JAMES R SMITH INSURANCE LTD3 Filed as: JAMES R. SMITH INSURANCE LTD | 333 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $675 | $2K | 1.59% |
| LAURIE SEUBERT3 | 333 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $259 | $2K | 1.28% |
| SHARON M BOSTON3 Filed as: SHARON M. BOSTON | 3400 LONGFIELD DRIVE SNELLVILLE, GA 30039 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $677 | $296 | $973 | 0.79% |
| DONNA LEE JORDAN3 | 18 FORGE ROAD KINGSTON, MA 02364 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $806 | $0 | $806 | 0.66% |
| JASON SCZEPANIAK3 Filed as: JASON C. SHAPIRO | 41 BRENTON STREET LITCHFIELD, NH 03052 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $480 | $96 | $576 | 0.47% |
| THERESA ANNE FERRIS3 | 5007 58TH TERRACE EAST BRADENTON, FL 34203 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $322 | $0 | $322 | 4.06% |
| LAURIE SEUBERT3 | 333 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $76 | $5 | $81 | 1.02% |
| JAMES R SMITH INSURANCE LTD3 Filed as: JAMES R. SMITH INSURANCE LTD | 333 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $70 | $11 | $81 | 1.02% |
| EMLYN MARSTELLER IV3 | 412 SUGARLAND MEADOW DRIVE HERNDON, VA 20170 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $70 | $3 | $73 | 0.92% |
| JASON SCZEPANIAK3 Filed as: JASON C. SHAPIRO | 41 BRENTON STREET LITCHFIELD, NH 03052 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $67 | $4 | $71 | 0.89% |
| FLEURY ENTERPRISES INC3 Filed as: FLEURY ENTERPRISES AND OTHER AGENTS | 162 INDIAN POINT ROAD TIVERTON, RI 02878 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $41 | $0 | $41 | 0.52% |
| ROBERT S. TAPPAN3 | 300 OHIO AVENUE MANCHESTER, NH 03104 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $25 | $0 | $25 | 0.32% |
| THERESA ANNE FERRIS3 | 5007 58TH TERRACE EAST BRADENTON, FL 34203 | THE PAUL REVERE LIFE INSURANCE COMPANY | $102 | $0 | $102 | 5.29% |
| AMY E COHEN3 Filed as: AMY SELAK | 6901 WALMORE ROAD NIAGRA FALLS, NY 14304 | THE PAUL REVERE LIFE INSURANCE COMPANY | $36 | $0 | $36 | 1.87% |
| LAURIE SEUBERT3 | 333 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $23 | $0 | $23 | 1.19% |
| DAVID J ROBERTS3 Filed as: DAVID J. ROBERTS | 167 NEVINS ROAD HENRIETTA, NY 14467 | THE PAUL REVERE LIFE INSURANCE COMPANY | $21 | $0 | $21 | 1.09% |
| JAMES R SMITH INSURANCE LTD3 Filed as: JAMES R. SMITH INSURANCE LTD | 333 MIAN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $20 | $0 | $20 | 1.04% |
| FLEURY ENTERPRISES INC3 Filed as: FLEURY ENTERPRISES INC. | 162 INDIAN POINT ROAD TIVERTON, RI 02878 | THE PAUL REVERE LIFE INSURANCE COMPANY | $7 | $0 | $7 | 0.36% |
| DAVID L FLEURY3 Filed as: DAVID L. FLEURY AND OTHER AGENTS | 162 INDIAN POINT ROAD TIVERTON, RI 02878 | THE PAUL REVERE LIFE INSURANCE COMPANY | $6 | $0 | $6 | 0.31% |
| THERESA ANNE FERRIS3 | 5007 58TH TERRACE EAST BRADENTON, FL 34203 | THE PAUL REVERE LIFE INSURANCE COMPANY | $42 | $0 | $42 | 5.17% |
| CHARLENE ALPAY3 | 606 WEST 116TH STREET NEW YORK, NY 10027 | THE PAUL REVERE LIFE INSURANCE COMPANY | $24 | $1 | $25 | 3.08% |
| JAMES R SMITH INSURANCE LTD3 Filed as: JAMES R. SMITH INSURANCE LTD | 333 MIAN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $4 | $9 | $13 | 1.60% |
| LAURIE SEUBERT3 | 333 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $6 | $2 | $8 | 0.99% |
| MICHELLE DARTEE3 | 58 FIELDSTONE TRAIL SPARTA, NJ 07871 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1 | $0 | $1 | 0.12% |
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 | 510 | 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) | 510 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 651 | $5.2M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 651 | $5.2M |
| Life insurance(5 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 510 | $274K |
| Short-term disability(4 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 120 | $134K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 510 | $141K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 651 | $5.2M |
| Other(4 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 510 | $273K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 651 | — |
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.