| 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 SAINT LOUIS, MO 63141 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $86K | $0 | $86K | 1.48% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | 721 EMERSON ROAD, SUITE 400 SAINT LOUIS, MO 63141 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $35K | $0 | $35K | 8.32% |
| THERESA ANNE FERRIS3 | 13 STAGECOACH LANE EAST BRIDGEWATER, MA 02333 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 1.97% |
| ROBERT D STEBBINS3 Filed as: ROBERT D. STEBBINS AND OTHER AGENTS | 25 STANDISH AVENUE SCITUATE, MA 02066 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $19 | $1K | 0.96% |
| JAMES R SMITH INSURANCE LTD3 Filed as: JAMES R. SMITH INSURANCE LTD | 50 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $955 | $0 | $955 | 0.83% |
| J KING INSURANCE INC3 Filed as: J KING INSURANCE, INC. | 50 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $519 | $365 | $884 | 0.77% |
| LAURIE SEUBERT3 | 50 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $778 | $63 | $841 | 0.73% |
| ALEXANDER JEFFREY SEUBERT3 | 480 ATLANTIC AVENUE WARWICK, RI 02888 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $235 | $7 | $242 | 0.21% |
| FLEURY ENTERPRISES INC3 Filed as: FLEURY ENTERPRISES, INC. | 162 INDIAN POINT ROAD TIVERTON, RI 02878 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $234 | $0 | $234 | 0.20% |
| THERESA ANNE FERRIS3 | 13 STAGECOACH LANE EAST BRIDGEWATER, MA 02333 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $98 | $0 | $98 | 2.51% |
| JAMES R SMITH INSURANCE LTD3 Filed as: JAMES R. SMITH INSURANCE LTD | 50 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $53 | $0 | $53 | 1.36% |
| LAURIE SEUBERT3 | 50 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $32 | $0 | $32 | 0.82% |
| EMLYN MARSTELLER IV3 | 412 SUGARLAND MEADOW DRIVE HERNDON, VA 20170 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $23 | $0 | $23 | 0.59% |
| FLEURY ENTERPRISES INC3 Filed as: FLEURY ENTERPRISES, INC. AND OTHERS | 162 INDIAN POINT ROAD TIVERTON, RI 02878 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $15 | $0 | $15 | 0.38% |
| ALEXANDER JEFFREY SEUBERT3 | 480 ATLANTIC AVENUE WARWICK, RI 02888 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $12 | $0 | $12 | 0.31% |
| JASON SCZEPANIAK3 Filed as: JASON C. SHAPIRO | 41 BRENTON STREET LITCHFIELD, NH 03052 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $10 | $0 | $10 | 0.26% |
| J KING INSURANCE INC3 Filed as: J KING INSURANCE, INC. | 50 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $193 | $112 | $305 | 9.13% |
| CHARLENE ALPAY3 | 606 WEST 116TH STREET NEW YORK, NY 10027 | THE PAUL REVERE LIFE INSURANCE COMPANY | $110 | $0 | $110 | 3.29% |
| LAURIE SEUBERT3 | 50 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $48 | $13 | $61 | 1.83% |
| THERESA ANNE FERRIS3 | 13 STAGECOACH LANE EAST BRIDGEWATER, MA 02333 | THE PAUL REVERE LIFE INSURANCE COMPANY | $37 | $0 | $37 | 1.11% |
| JAMES R SMITH INSURANCE LTD3 Filed as: JAMES R. SMITH INSURANCE LTD | 50 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $24 | $0 | $24 | 0.72% |
| AMY SELAK AND OTHER AGENTS3 | 6901 WALMORE ROAD NIAGARA FALLS, NY 14304 | THE PAUL REVERE LIFE INSURANCE COMPANY | $17 | $0 | $17 | 0.51% |
| MICHELLE DARTEE3 | 58 FIELDSTONE TRAIL SPARTA, NJ 07871 | THE PAUL REVERE LIFE INSURANCE COMPANY | $16 | $0 | $16 | 0.48% |
| JAMES R SMITH INSURANCE LTD3 Filed as: JAMES R. SMITH INSURANCE LTD | 50 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $88 | $0 | $88 | 5.41% |
| LAURIE SEUBERT3 | 50 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $16 | $0 | $16 | 0.98% |
| CHARLENE ALPAY3 | 606 WEST 116TH STREET NEW YORK, NY 10027 | THE PAUL REVERE LIFE INSURANCE COMPANY | $8 | $0 | $8 | 0.49% |
| MICHELLE DARTEE3 | 58 FIELDSTONE TRAIL SPARTA, NJ 07871 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2 | $0 | $2 | 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 | 661 | 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) | 661 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 743 | $5.8M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 743 | $5.8M |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 661 | $425K |
| Life insurance(5 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 661 | $549K |
| Short-term disability(4 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 109 | $124K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 661 | $425K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 743 | $5.8M |
| Other(4 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 661 | $548K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 743 | — |
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.