| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLUE BACK, LLC3 Filed as: BLUE BACK HEALTH, LLC | 20 WESTERN BLVD GLASTONBURY, CT 06033 | STANDARD INSURANCE COMPANY | $10K | $0 | $10K | 13.20% |
| BLUE BACK, LLC3 Filed as: BLUE BACK HEALTH, LLC | 20 WESTERN BLVD GLASTONBURY, CT 06033 | GUARDIAN LIFE INSURANCE COMPANY | $2K | $0 | $2K | 5.58% |
| BLUE BACK, LLC3 Filed as: BLUE BACK HEALTH, LLC | 20 WESTERN BLVD GLASTONBURY, CT 06033 | ANTHEM LIFE INSURANCE COMPANY | $3K | $0 | $3K | 20.08% |
| MICHAEL T REYES3 Filed as: MICHAEL K BROOKS | 190 STILL HILL ROAD HAMDEN, CT 06518 | AFLAC | $945 | $76 | $1K | 6.10% |
| BLUE BACK, LLC3 Filed as: BLUE BACK HEALTH, LLC | 20 WESTERN BLVD GLASTONBURY, CT 06033 | AFLAC | $602 | $0 | $602 | 3.60% |
| ALONZO EDWARDS3 | 2390 STATE STREET HOUSE #13 HAMDEN, CT 06460 | AFLAC | $153 | $0 | $153 | 0.91% |
| STEPHEN WEST3 Filed as: STEPHEN E WEST | 5 JANE STREET BEACON FALLS, CT 06403 | AFLAC | $133 | $12 | $145 | 0.87% |
| THOMAS P MCKIERNAN3 | 687 E BROADWAY MILFORD, CT 06460 | AFLAC | $135 | $0 | $135 | 0.81% |
| CHRISTOPHER MCKIERNAN3 | 9 MARINO DR MILFORD, CT 06824 | AFLAC | $120 | $12 | $132 | 0.79% |
| MICHAEL REYES3 Filed as: MICHAEL ROBERTS | 110 LIMERICK ROAD FAIRFIELD, CT 06824 | AFLAC | $67 | $0 | $67 | 0.40% |
| MATTHEW G BERGER3 Filed as: MATTHEW BERGER | 10 UNION AVE - APT 302 BALA CYNWYD, PA 19004 | AFLAC | $27 | $0 | $27 | 0.16% |
| JONATHAN THOMSON3 | 245 UNQUOWA ROAD- APT 16 FAIRFIELD, CT 06824 | AFLAC | $20 | $0 | $20 | 0.12% |
| CROSS INSURANCE3 | 2 CORPORATE DRIVE SUITE 335 SHELTON, CT 06484 | AFLAC | $15 | $0 | $15 | 0.09% |
| MARILENA K GREIG3 Filed as: MARILENA K GRIEIG | 54 SAINT GEORGE LANE NEW CANAAN, CT 06840 | AFLAC | $13 | $0 | $13 | 0.08% |
| JOHN K SCHULE3 | 102 BLACKWOOD LN STAMFORD, CT 06903 | AFLAC | $9 | $0 | $9 | 0.05% |
| CHRISTOPHER S AUSTERMANN3 | 41 NEW LONDON TPKE GLASTONBURY, CT 06033 | AFLAC | $8 | $0 | $8 | 0.05% |
| MICHAEL REYES3 | 185 PLAINS ROAD STE 200E MILFORD, CT 06461 | AFLAC | $7 | $0 | $7 | 0.04% |
| JUSTIN GRIFFEY3 | 7 MICHELE CARLISLE, PA 06461 | AFLAC | $7 | $0 | $7 | 0.04% |
| CHRISTIAN PAUL VIRZI3 | 34 BLACK BEAR DR UNIT 1101 WALTHAM, MA 02451 | AFLAC | $1 | $0 | $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 | 299 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 53 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 352 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN LIFE INSURANCE COMPANY | 190 | $38K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY | 190 | $38K |
| Life insurance(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 224 | $96K |
| Short-term disability | ANTHEM LIFE INSURANCE COMPANY | 222 | $17K |
| Long-term disability(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 224 | $96K |
| Other(3 contracts, 3 carriers) | STANDARD INSURANCE COMPANY | 224 | $113K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 224 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.