| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE CO EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVE RE11 HARTFORD, CT 06156 | $1.6M |
| THE SEGAL COMPANY EIN 13-1835864 PLAN ACTUARY | Actuarial Service code 11 | 30 WATERSIDE DRIVE, SUITE 300 FARMINGTON, CT 060323069 | $119K |
| DIANE KLOBUKOWSKI EXECUTIVE DIRECTOR | Employee (plan) Service code 30 | 435 CAPTAIN THOMAS BOULEVARD WEST HAVEN, CT 06516 | $98K |
| LORI FREDETTE EMPLOYEE | Employee (plan) Service code 30 | 435 CAPTAIN THOMAS BOULEVARD WEST HAVEN, CT 06516 | $93K |
| CRAIG TAYLOR EMPLOYEE | Employee (plan) Service code 30 | 435 CAPTAIN THOMAS BOULEVARD WEST HAVEN, CT 06516 | $54K |
| ALDA RUZICKA EMPLOYEE | Employee (plan) Service code 30 | 435 CAPTAIN THOMAS BOULEVARD WEST HAVEN, CT 06516 | $46K |
| ROBERT M. CHEVERIE & ASSOCIATES P.C EIN 06-1335139 PLAN ATTORNEY | Legal Service code 29 | 333 EAST RIVER DRIVE, SUITE 101 EAST HARTFORD, CT 06108 | $38K |
| SEGAL MARCO ADVISORS EIN 13-2646110 INVESTMENT ADVISOR | Investment advisory (plan) Service code 27 | 333 WEST 34TH STREET NEW YORK, NY 100012402 | $37K |
| KIMBERLY MAGNANI EMPLOYEE | Employee (plan) Service code 30 | 435 CAPTAIN THOMAS BOULEVARD WEST HAVEN, CT 06516 | $37K |
| TERESLY QUINTANA EMPLOYEE | Employee (plan) Service code 30 | 435 CAPTAIN THOMAS BOULEVARD WEST HAVEN, CT 06516 | $35K |
| CVS PHARMACY, INC. EIN 05-0340626 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $34K |
| RICKY FREE EMPLOYEE | Employee (plan) Service code 30 | 435 CAPTAIN THOMAS BOULEVARD WEST HAVEN, CT 06516 | $33K |
| HOPE DACEY EMPLOYEE | Employee (plan) Service code 30 | 435 CAPTAIN THOMAS BOULEVARD WEST HAVEN, CT 06516 | $30K |
| T.M. BYXBEE CO. EIN 06-1386456 ACCOUNTANT | Accounting (including auditing) Service code 10 | 2319 WHITNEY AVE HAMDEN, CT 06518 | $30K |
| RBS CITIZENS EIN 05-6073921 INVESTMENT CUSTODIAN | Custodial (securities); Custodial (other than securities) Service code 18 | ONE CITIZENS PLAZA PROVIDENCE, RI 02903 | $17K |
| DAVIS VISION EIN 11-3051991 VISION BENEFITS ADMINISTR | Contract Administrator Service code 13 | 175 E. HOUSTON STREET 5TH FLOOR SAN ANTONIO, TX 78205 | $17K |
| SEGAL SELECT INSURANCE SERVICES | Insurance brokerage commissions and fees Service code 53 | — | $7K |
| STATE STREET GLOBAL ADVISORS TRUST EIN 81-4017137 INVESTMENT CUSTODIAN | Custodial (securities); Investment management fees paid directly by plan Service code 19 | ONE LINCOLN STREET BOSTON, MA 02111 | $5K |
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 | 2,588 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,474 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 4,062 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | HARTFORD LIFE AND ACCIDENT | 3,223 | $391K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 2,747 | $836K |
| Other | HARTFORD LIFE AND ACCIDENT | 2,466 | $45K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,223 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Filing reports zero broker compensation on a plan over 100 participants. Likely direct-write or unreported — worth a knock.