| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | 721 EMERSON ROAD, SUITE 400 ST. LOUIS, MO 63141 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $74K | $3K | $78K | 1.36% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | 721 EMERSON ROAD, SUITE 400 ST. LOUIS, MO 63141 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $26K | $5K | $30K | 8.20% |
| J KING INSURANCE INC3 Filed as: J KING INSURANCE INC. | 333 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $2K | $4K | 2.87% |
| SUZANNE BRATTON TUCKER3 Filed as: SUZANNE B. TUCKER AND OTHER AGENTS | PO BOX 22518 LEXINGTON, KY 40522 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $217 | $3K | 2.22% |
| THERESA ANNE FERRIS3 | 5007 58TH TERRACE EAST BRADENTON, FL 34203 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $0 | $3K | 2.08% |
| 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 | $438 | $2K | 1.45% |
| LAURIE SEUBERT3 | 333 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $58 | $1K | 1.03% |
| JULIET A BRUNO3 Filed as: JULIET A. BRUNO | 3926 RENZI ROAD RARITAN, NJ 33904 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $808 | — | $808 | 0.66% |
| ALEXANDER JEFFREY SEUBERT3 | 480 ATLANTIC AVENUE WARWICK, RI 02888 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $457 | $9 | $466 | 0.38% |
| THERESA ANNE FERRIS3 | 5007 58TH TERRACE EAST BRADENTON, FL 34203 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $106 | $0 | $106 | 2.46% |
| 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 | $65 | $10 | $75 | 1.74% |
| LAURIE SEUBERT3 | 333 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $36 | $0 | $36 | 0.83% |
| EMLYN MARSTELLER IV3 | 412 SUGARLAND MEADOW DRIVE HERNDON, VA 20170 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $24 | $0 | $24 | 0.56% |
| ALEXANDER JEFFREY SEUBERT3 | 480 ATLANTIC AVENUE WARWICK, RI 02888 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $20 | $0 | $20 | 0.46% |
| MJ INSURANCE3 Filed as: FLEURY ENTERPRISES & VARIOUS AGENTS | 162 INDIAN POINT ROAD TIVERTON, RI 02878 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $19 | $0 | $19 | 0.44% |
| JASON SCZEPANIAK3 Filed as: JASON C. SHAPIRO | 41 BRENTON STREET LITCHFIELD, NH 03052 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $11 | $0 | $11 | 0.25% |
| J KING INSURANCE INC3 Filed as: J KING INSURANCE INC. | 333 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $436 | $30 | $466 | 13.88% |
| CHARLENE ALPAY3 | 606 WEST 116TH STREET NEW YORK, NY 10027 | THE PAUL REVERE LIFE INSURANCE COMPANY | $356 | $0 | $356 | 10.60% |
| LAURIE SEUBERT3 | 333 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $90 | $2 | $92 | 2.74% |
| JAMES R SMITH INSURANCE LTD3 Filed as: JAMES R. SMITH INSURANCE LTD. | 333 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $37 | $19 | $56 | 1.67% |
| MICHELLE DARTEE3 | 58 FIELDSTONE TRAIL SPARTA, NJ 07871 | THE PAUL REVERE LIFE INSURANCE COMPANY | $49 | $0 | $49 | 1.46% |
| THERESA ANNE FERRIS3 | 5007 58TH TERRACE EAST BRADENTON, FL 34203 | THE PAUL REVERE LIFE INSURANCE COMPANY | $37 | $0 | $37 | 1.10% |
| MJ INSURANCE3 Filed as: AMY SELAK AND VARIOUS AGENTS | 6901 WALMORE ROAD NIAGARA FALLS, NY 14304 | THE PAUL REVERE LIFE INSURANCE COMPANY | $25 | $0 | $25 | 0.74% |
| JAMES R SMITH INSURANCE LTD3 Filed as: JAMES R. SMITH INSURANCE LTD. | 333 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $147 | $38 | $185 | 9.49% |
| CHARLENE ALPAY3 | 606 WEST 116TH STREET NEW YORK, NY 10027 | THE PAUL REVERE LIFE INSURANCE COMPANY | $65 | $0 | $65 | 3.33% |
| LAURIE SEUBERT3 | 333 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $30 | $0 | $30 | 1.54% |
| MICHELLE DARTEE3 | 58 FIELDSTONE TRAIL SPARTA, NJ 07871 | THE PAUL REVERE LIFE INSURANCE COMPANY | $10 | $0 | $10 | 0.51% |
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 | 641 | 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) | 641 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 803 | $5.7M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 803 | $5.7M |
| Life insurance(5 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 641 | $503K |
| Short-term disability(4 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 129 | $132K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 641 | $371K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 803 | $5.7M |
| Other(4 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 641 | $501K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 803 | — |
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.