| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLUE BACK, LLC3 Filed as: BLUE BACK HEALTH, LLC | 20 WESTERN BLVD GLASTONBURY, CT 06033 | ANTHEM LIFE INSURANCE COMPANY | $15K | — | $15K | 10.55% |
| BLUE BACK, LLC3 Filed as: BLUE BACK HEALTH, LLC | 20 WESTERN BLVD GLASTONBURY, CT 06033 | GUARDIAN LIFE INSURANCE COMPANY | $215K | $0 | $215K | 556.45% |
| MICHAEL T REYES3 Filed as: MICHAEL K BROOKS | 190 STILL HILL ROAD HAMDEN, CT 06518 | AFLAC | $1K | $0 | $1K | 7.20% |
| BLUE BACK, LLC3 Filed as: BLUE BACK HEALTH, LLC | 20 WESTERN BLVD GLASTONBURY, CT 06033 | AFLAC | $1K | $0 | $1K | 5.38% |
| CHRISTOPHER M. MCKIERNAN3 Filed as: CHRISTOPHER M MCKIERNAN | 9 MARINO DRIVE MILFORD, CT 06460 | AFLAC | $262 | $0 | $262 | 1.37% |
| STEPHEN WEST3 Filed as: STEPHEN E WEST | 5 JANE STREET BEACON FALLS, CT 06403 | AFLAC | $223 | $0 | $223 | 1.16% |
| ALONZO L EDWARDS3 | 2390 STATE STREET HOUSE #13 HAMDEN, CT 06517 | AFLAC | $171 | $0 | $171 | 0.89% |
| THOMAS P MCKIERNAN3 | 687 EAST BROADWAY MILFORD, CT 06460 | AFLAC | $157 | $0 | $157 | 0.82% |
| MICHAEL REYES3 Filed as: MICHAEL R ROBERTS | 110 LIMERICK ROAD FAIRFIELD, CT 06824 | AFLAC | $83 | $0 | $83 | 0.43% |
| MATTHEW G BERGER3 | 22 SUNNYRIDGE ROAD 4TH FLOOR PHILADELPHIA, CT 19125 | AFLAC | $35 | $0 | $35 | 0.18% |
| JONATHAN THOMSON3 | 245 UNQUOWA ROAD - APT 16 FAIRFIELD, CT 06824 | AFLAC | $20 | $0 | $20 | 0.10% |
| JOHN K SCHULE3 Filed as: JOHN K SHULE | 102 BLACKWOOD LANE STAMFORD, CT 06903 | AFLAC | $13 | $0 | $13 | 0.07% |
| MARILENA K GREIG3 | 54 ST. GEORGE LANE NEW CANAAN, CT 06840 | AFLAC | $13 | $0 | $13 | 0.07% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE INC. CONNECTICUT | 2 CORPORATE DRIVE - SUITE 335 SHELTON, CT 06484 | AFLAC | $13 | $0 | $13 | 0.07% |
| MICHAEL T REYES3 | 185 PLAINS ROAD - SUITE 200E MILFORD, CT 06461 | AFLAC | $12 | $0 | $12 | 0.06% |
| CHRISTOPHER S AUSTERMANN3 | 41 NEW LONDON TPKE - NUMBER B GLASTONBURY, CT 06033 | AFLAC | $11 | $0 | $11 | 0.06% |
| JUSTIN GRIFFEY3 | 7 MICHELE DRIVE CARLISLE, PA 17013 | AFLAC | $7 | $0 | $7 | 0.04% |
| CHRISTIAN PAUL VIRZI3 | 34 BLACK BEAR DRIVE UNIT 1101 WALTHAM, MA 02451 | AFLAC | $2 | $0 | $2 | 0.01% |
| ACBI, INC.3 | 2 CORPORATE DRIVE - SUITE 335 SHELTON, CT 06484 | AFLAC | $1 | — | $1 | 0.01% |
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 | 304 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 50 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 354 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN LIFE INSURANCE COMPANY | 178 | $39K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 242 | $138K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 242 | $138K |
| Other(2 contracts, 2 carriers) | ANTHEM LIFE INSURANCE COMPANY | 242 | $157K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 242 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.