| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS | PO BOX 93964 CLEVELAND, OH 44101 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $105K | $0 | $105K | 1.50% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS | 721 EMERSON ROAD, SUITE 400 SAINT LOUIS, MO 63141 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $41K | $0 | $41K | 6.57% |
| J KING INSURANCE INC3 Filed as: J KING INSURANCE, INC. | 50 MAIN STREET, SUITE 200 EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $875 | $2K | 2.20% |
| THERESA ANNE FERRIS3 | 13 STAGECOACH LANE EAST BRIDGEWATER, MA 02333 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 1.75% |
| 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 | $807 | $0 | $807 | 0.77% |
| LAURIE SEUBERT3 | 50 MAIN STREET, SUITE 200 EAST GREENWICH, RI 02818 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $754 | $48 | $802 | 0.76% |
| FLEURY ENTERPRISES INC3 Filed as: FLEURY ENTERPRISES, INC & OTHER AGT | 162 INDIAN POINT ROAD TIVERTON, RI 02878 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $737 | $4 | $741 | 0.70% |
| ALEXANDER JEFFREY SEUBERT3 | 480 ATLANTIC AVENUE WARWICK, RI 02888 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $657 | $47 | $704 | 0.67% |
| JASON SCZEPANIAK3 Filed as: JASON C. SHAPIRO | 41 BRENTON STREET LITCHFIELD, NH 03052 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $113 | $12 | $125 | 0.12% |
| J KING INSURANCE INC3 Filed as: J KING INSURANCE, INC. | 50 MAIN STREET, SUITE 200 EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $636 | $258 | $894 | 18.69% |
| MARY DAUGHERTY3 | PO BOX 119 ROCKY TOP, TN 37769 | THE PAUL REVERE LIFE INSURANCE COMPANY | $219 | $29 | $248 | 5.18% |
| LAURIE SEUBERT3 | 50 MAIN STREET, SUITE 200 EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $154 | $14 | $168 | 3.51% |
| CHARLENE ALPAY3 | 606 WEST 116TH STREET NEW YORK, NY 10027 | THE PAUL REVERE LIFE INSURANCE COMPANY | $45 | $0 | $45 | 0.94% |
| BENEFOUNDRY INC3 Filed as: BENEFOUNDRY, INC. | 3013 LARGE HOP LANE ANTIOCH, TN 37013 | THE PAUL REVERE LIFE INSURANCE COMPANY | $28 | $0 | $28 | 0.59% |
| 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 | $13 | $0 | $13 | 0.27% |
| MICHELLE DARTEE3 | PO BOX 274 SPARTA, NJ 07871 | THE PAUL REVERE LIFE INSURANCE COMPANY | $3 | $0 | $3 | 0.06% |
| 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 | $84 | $0 | $84 | 5.89% |
| CHARLENE ALPAY3 | 606 WEST 116TH STREET NEW YORK, NY 10027 | THE PAUL REVERE LIFE INSURANCE COMPANY | $31 | $0 | $31 | 2.17% |
| LAURIE SEUBERT3 | 50 MAIN STREET, SUITE 200 EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $16 | $0 | $16 | 1.12% |
| MICHELLE DARTEE3 | PO BOX 274 SPARTA, NJ 07871 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2 | $0 | $2 | 0.14% |
| THERESA ANNE FERRIS3 | 13 STAGECOACH LANE EAST BRIDGEWATER, MA 02333 | THE PAUL REVERE LIFE INSURANCE COMPANY | $16 | $0 | $16 | 4.60% |
| AMY E COHEN3 Filed as: AMY SELAK | 6901 WALMORE ROAD NIAGARA FALLS, NY 14304 | THE PAUL REVERE LIFE INSURANCE COMPANY | $9 | $0 | $9 | 2.59% |
| LAURIE SEUBERT3 | 50 MAIN STREET, SUITE 200 EAST GREENWICH, RI 02818 | THE PAUL REVERE LIFE INSURANCE COMPANY | $3 | $0 | $3 | 0.86% |
| 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 | $3 | $0 | $3 | 0.86% |
| FLEURY ENTERPRISES INC3 Filed as: FLEURY ENTERPRISES, INC. | 162 INDIAN POINT ROAD TIVERTON, RI 02878 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2 | $0 | $2 | 0.57% |
| STEPHEN JOSEPH JOYCE3 | 33 GATES CIRCLE, APARTMENT 2D BUFFALO, NY 14209 | THE PAUL REVERE LIFE INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
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 | 488 | 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) | 488 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 824 | $7.0M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 824 | $7.0M |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 735 | $619K |
| Life insurance(5 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 735 | $731K |
| Short-term disability(4 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 98 | $112K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 735 | $619K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 824 | $7.0M |
| Other(4 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 735 | $729K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 824 | — |
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.