| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: ASSURED SKCG INC | 123 MAIN STREET 14TH FLOOR WHITE PLAINS, NY 10601 | BLUE CROSS BLUE SHIELD OF RHODE ISLAND | -$80 | $106K | $106K | 3.21% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS NORTHEAST, LLC | 123 MAIN STREET 14TH FLOOR WHITE PLAINS, NY 10601 | DELTA DENTAL OF RHODE ISLAND | $7K | — | $7K | 2.32% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS NORTHEAST, LLC | 123 MAIN ST. 14TH FLOOR WHITE PLAINS, NY 10601 | FOUR EVER LIFE INS CO | $13K | — | $13K | 10.00% |
| BLUE CROSS BLUE SHIELD OF FLORIDA3 Filed as: BLUE CROSS BLUE SHIELD OF RHODE ISL | 500 EXCHANGE STREET PROVIDENCE, RI 02903 | FOUR EVER LIFE INS CO | — | $5K | $5K | 4.00% |
| ASSUREDPARTNERS3 Filed as: ASSURED SKCG INC | 123 MAIN ST 14TH FLOOR WHITE PLAINS, NY 10601 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 4.95% |
| ASSUREDPARTNERS3 Filed as: ASSURED SKCG INC | 123 MAIN ST 14TH FLOOR WHITE PLAINS, NY 10601 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | — | $5K | 8.33% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS NORTHEAST LLC | 123 MAIN STREET 14TH FLOOR WHITE PLAINS, NY 10601 | VISION SERVICE PLAN | $2K | — | $2K | 3.76% |
| THOMAS R KOZERA3 | 123 MAIN STREET 14TH FLOOR WHITE PLAINS, NY 10601 | ZURICH AMERICAN LIFE INSURANCE COMPANY | $373 | — | $373 | 6.78% |
| TOMMY TAM3 | 418 EAST 74TH STREET NEW YORK, NY 10021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 1.32% |
| USI INSURANCE SERVICES LLC3 | 12 GILL STREET STE 5500 WOBURN, MA 01801 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.72% |
| KRISTY COLGATE3 | 43 MAGILL DR. GRAFTON, MA 01519 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.50% |
| RICHARD WILLIAM HARRINGTON3 | 3 POISSON STREET CUMBERLAND, RI 02864 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.44% |
| ENROLLMENT SOLUTIONS LTD3 | 65 BURBANK RD SUTTON, MA 01590 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.39% |
| FLEURY ENTERPRISES INC3 | 162 INDIAN POINT RD TIVERTON, RI 02878 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.11% |
| USI INSURANCE SERVICES LLC3 | 12 GILL STREET STE 5500 WOBURN, MA 01801 | THE PAUL REVERE LIFE INSURANCE COMPANY | $10 | — | $10 | 1.89% |
| KRISTY COLGATE3 | 43 MAGILL DR GRAFTON, MA 01519 | THE PAUL REVERE LIFE INSURANCE COMPANY | $7 | — | $7 | 1.33% |
| THOMAS E KIENZLER3 | 359 WASHINGTON RD ENFIELD, CT 06082 | THE PAUL REVERE LIFE INSURANCE COMPANY | $6 | — | $6 | 1.14% |
| ENROLLMENT SOLUTIONS LTD3 | 65 BURBANK RD SUTTON, MA 01590 | THE PAUL REVERE LIFE INSURANCE COMPANY | $5 | — | $5 | 0.95% |
| FLEURY ENTERPRISES INC3 | 162 INDIAN POINT RD TIVERTON, RI 02878 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2 | — | $2 | 0.38% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INTERFLEX PAYMENTS, LLC EIN 27-2256926 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $11K |
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 | 209 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 216 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF RHODE ISLAND | 216 | $3.4M |
| Dental | DELTA DENTAL OF RHODE ISLAND | 537 | $295K |
| Vision | VISION SERVICE PLAN | 217 | $50K |
| Life insurance(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 189 | $74K |
| Long-term disability(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 189 | $64K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF RHODE ISLAND | 216 | $3.3M |
| Other(4 contracts, 4 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 206 | $72K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 537 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.