| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | PO BOX 632886 CINCINNATTI, OH 45263 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $76K | $14K | $90K | 1.67% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | PO BOX 632886 CINCINNATTI, OH 45263 | HARTFORD LIFE AND ACCIDENT | $18K | $0 | $18K | 10.00% |
| INDIGO INSURANCE SERVICES3 Filed as: INDIGO INSURANCE SERVICES LLC | 100 FRONT STREET, 20TH FLOOR WORCESTER, MA 01608 | HARTFORD LIFE AND ACCIDENT | $0 | $13K | $13K | 7.00% |
| ALEXANDER JEFFREY SEUBERT3 Filed as: ALEXANDER SEUBERT AND OTHER AGENTS | 480 ATLANTIC AVENUE WARWICK, RI 02888 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $302 | $4K | 3.05% |
| THERESA ANNE FERRIS3 | 5007 58TH TERRACE EAST BRADENTON, FL 34203 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $0 | $4K | 3.02% |
| JAMES R SMITH INSURANCE LTD3 Filed as: JAMES R. SMITH INSURANCE | 333 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $1K | $4K | 2.83% |
| LAURIE SEUBERT3 | 333 EAST GREENWICH AVENUE WEST WARWICK, RI 02893 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $239 | $2K | 1.34% |
| DONNA LEE JORDAN3 Filed as: DONNA LEE JPRDAN | 18 FORGE ROAD KINGSTON, MA 02364 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $707 | $0 | $707 | 0.53% |
| KC BENEFITS LLC3 | 2376 DUNWOODY CROSSING ATLANTA, GA 30338 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $619 | $29 | $648 | 0.49% |
| THOMAS F HAYES3 Filed as: THOMAS F. HAYES | 2205 OREGON PIKE LANCASTER, PA 17601 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $608 | $0 | $608 | 0.46% |
| JAMES R SMITH INSURANCE LTD3 Filed as: JAMES R. SMITH INSURANCE | 333 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $139 | $82 | $221 | 3.58% |
| THERESA ANNE FERRIS3 | 5007 58TH TERRACE EAST BRADENTON, FL 34203 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $185 | $0 | $185 | 2.99% |
| ALEXANDER JEFFREY SEUBERT3 | 480 ATLANTIC AVENUE WARWICK, RI 02888 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $76 | $8 | $84 | 1.36% |
| LAURIE SEUBERT3 | 333 EAST GREENWICH AVENUE WEST WARWICK, RI 02893 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $65 | $5 | $70 | 1.13% |
| FLEURY ENTERPRISES INC3 Filed as: FLEURY ENTERPRISES AND OTHER AGENTS | 162 INDIAN POINT ROAD TIVERTON, RI 02878 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $38 | $0 | $38 | 0.61% |
| EMLYN MARSTELLER IV3 Filed as: EMLYN MARSTELLER | 412 SUGARLAND MEADOW DRIVE HERNDON, VA 20170 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $26 | $0 | $26 | 0.42% |
| JASON SCZEPANIAK3 Filed as: JASON C. SHAPIRO | 41 BRENTON STREET LITCHFIELD, NH 03052 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $24 | $0 | $24 | 0.39% |
| JAMES R SMITH INSURANCE LTD3 Filed as: JAMES R. SMITH INSURANCE | 333 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $302 | $141 | $443 | 23.78% |
| CHARLENE ALPAY3 | 606 WEST 116TH STREET NEW YORK, NY 10027 | THE PAUL REVERE LIFE INSURANCE COMPANY | $286 | $54 | $340 | 18.25% |
| LAURIE SEUBERT3 | 333 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $69 | $67 | $136 | 7.30% |
| MICHELLE DARTEE3 | 58 FIELDSTONE TRAIL SPARTA, NJ 07871 | THE PAUL REVERE LIFE INSURANCE COMPANY | $41 | $11 | $52 | 2.79% |
| THERESA ANNE FERRIS3 | 5007 58TH TERRACE EAST BRADENTON, FL 34203 | THE PAUL REVERE LIFE INSURANCE COMPANY | $5 | $0 | $5 | 0.27% |
| THERESA ANNE FERRIS3 | 5007 58TH TERRACE EAST BRADENTON, FL 34203 | THE PAUL REVERE LIFE INSURANCE COMPANY | $42 | $0 | $42 | 2.59% |
| AMY E COHEN3 Filed as: AMY SELAK | 6901 WALMORE ROAD NIAGARA FALLS, NY 14304 | THE PAUL REVERE LIFE INSURANCE COMPANY | $22 | $0 | $22 | 1.36% |
| LAURIE SEUBERT3 | 333 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $9 | $0 | $9 | 0.55% |
| JAMES R SMITH INSURANCE LTD3 Filed as: JAMES R. SMITH INSURANCE | 333 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $8 | $0 | $8 | 0.49% |
| FLEURY ENTERPRISES INC3 | 162 INDIAN POINT ROAD TIVERTON, RI 02878 | THE PAUL REVERE LIFE INSURANCE COMPANY | $4 | $0 | $4 | 0.25% |
| MJ INSURANCE3 Filed as: STEPHEN JOYCE AND VARIOUS AGENTS | 70 SARGENT DRIVE AMHERST, NY 14226 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1 | $0 | $1 | 0.06% |
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 | 534 | 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) | 534 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 672 | $5.4M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 672 | $5.4M |
| Life insurance(5 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 534 | $321K |
| Short-term disability(4 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 136 | $142K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 534 | $179K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 672 | $5.4M |
| Other(4 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 534 | $320K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 672 | — |
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.