| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP | 5110 N 40TH STREET SUITE 234 PHOENIX, AZ 85018 | AETNA LIFE INSURANCE CO. | $25K | — | $25K | 1.43% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF CONNECTICUT LLC | 185 ASYLUM STREET 25TH FLOOR HARTFORD, CT 06103 | HARTFORD LIFE AND ACCIDENT | $10K | $2K | $11K | 13.68% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WILLIS OF CONNECTICUT EIN 52-2285571 BROKER | Insurance agents and brokers Service code 22 | P. O. BOX 414965 BOSTON, MA 02241 | $43K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVENUE HARTFORD, CT 06156 | $12K |
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 | 180 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 180 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 295 | $1.8M |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 167 | $83K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 167 | $83K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 295 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.