| 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. | $97K | $0 | $97K | 1.55% |
| 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 | $42K | $12K | $54K | 9.59% |
| J KING INSURANCE INC3 Filed as: J. KING INSURANCE, INC. | 50 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $4K | $7K | 5.80% |
| THERESA ANNE FERRIS3 | 13 STAGECOACH LANE EAST BRIDGEWATER, MA 02333 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 1.59% |
| JASON SCZEPANIAK3 Filed as: JASON C. SHAPIRO | 41 BRENTON STREET LITCHFIELD, NH 03052 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $332 | $1K | 1.18% |
| LAURIE SEUBERT3 | 50 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $263 | $1K | 1.06% |
| JASON R SMITH3 Filed as: JASON R. SMITH AND OTHER AGENTS | 50 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $965 | $70 | $1K | 0.85% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R. NELLIGAN INSURANCE LTD. | 50 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $827 | $0 | $827 | 0.68% |
| ALEXANDER JEFFREY SEUBERT3 | 480 ATLANTIC AVENUE WARWICK, RI 02888 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $671 | $30 | $701 | 0.58% |
| J KING INSURANCE INC3 Filed as: J. KING INSURANCE, INC. | 50 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $371 | $124 | $495 | 13.79% |
| LAURIE SEUBERT3 | 50 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $259 | $93 | $352 | 9.81% |
| THERESA ANNE FERRIS3 | 13 STAGECOACH LANE EAST BRIDGEWATER, MA 02333 | THE PAUL REVERE LIFE INSURANCE COMPANY | $31 | $0 | $31 | 0.86% |
| AMY E COHEN3 Filed as: AMY SELAK | 6901 WALMORE ROAD NIAGARA FALLS, NY 14304 | THE PAUL REVERE LIFE INSURANCE COMPANY | $17 | $0 | $17 | 0.47% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R. NELLIGAN INSURANCE LTD. | 50 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $15 | $0 | $15 | 0.42% |
| CHARLENE ALPAY3 | 606 WEST 116TH STREET NEW YORK, NY 10027 | THE PAUL REVERE LIFE INSURANCE COMPANY | $8 | $0 | $8 | 0.22% |
| FLEURY ENTERPRISES INC3 Filed as: FLEURY ENTERPRISES, INC. AND OTHERS | 162 INDIAN POINT ROAD TIVERTON, RI 02878 | THE PAUL REVERE LIFE INSURANCE COMPANY | $6 | $0 | $6 | 0.17% |
| THERESA ANNE FERRIS3 | 13 STAGECOACH LANE EAST BRIDGEWATER, MA 02333 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $81 | $0 | $81 | 2.61% |
| J KING INSURANCE INC3 Filed as: J. KING INSURANCE, INC. | 50 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $27 | $41 | $68 | 2.19% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R. NELLIGAN INSURANCE LTD. | 50 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $45 | $0 | $45 | 1.45% |
| LAURIE SEUBERT3 | 50 MAIN STREET EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $28 | $2 | $30 | 0.97% |
| ALEXANDER JEFFREY SEUBERT3 Filed as: ALEXANDER JEFFREY SEUBERT & OTHERS | 480 ATLANTIC AVENUE WARWICK, RI 02888 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $23 | $0 | $23 | 0.74% |
| JASON SCZEPANIAK3 Filed as: JASON C. SHAPIRO | 41 BRENTON STREET LITCHFIELD, NH 03052 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $17 | $4 | $21 | 0.68% |
| EMLYN MARSTELLER IV3 | 412 SUGARLAND MEADOW DRIVE HERNDON, VA 20170 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $17 | $0 | $17 | 0.55% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R. NELLIGAN INSURANCE LTD. | 50 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $86 | $0 | $86 | 5.10% |
| LAURIE SEUBERT3 | 50 MAIN STREET EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $16 | $0 | $16 | 0.95% |
| CHARLENE ALPAY3 | 606 WEST 116TH STREET NEW YORK, NY 10027 | THE PAUL REVERE LIFE INSURANCE COMPANY | $8 | $0 | $8 | 0.47% |
| MICHELLE DARTEE3 | PO BOX 274 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 | 457 | 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) | 457 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 759 | $6.3M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 759 | $6.3M |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 726 | $558K |
| Life insurance(5 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 726 | $688K |
| Short-term disability(4 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 107 | $129K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 726 | $558K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 759 | $6.3M |
| Other(4 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 726 | $686K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 759 | — |
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.