| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NA | — | AETNA LIFE INSURANCE CO. | — | — | $0 | 0.00% |
| NA | — | THE UNION LABOR LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| THE SEGAL COMPANY Filed as: THE SEGAL COMPANY EASTERN STATES IN | 1800 M STREET NW, STE 900 S WASHINGTON, DC 20036 | HARTFORD LIFE AND ACCIDENT | — | $3K | $3K | 1.68% |
| 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 | $2.0M |
| THE SEGAL COMPANY EIN 13-1835864 PLAN ACTUARY | Actuarial Service code 11 | 30 WATERSIDE DRIVE, SUITE 300 FARMINGTON, CT 060323069 | $156K |
| SUSAN HENDERSON EMPLOYEE | Employee (plan) Service code 30 | 435 CAPTAIN THOMAS BOULEVARD WEST HAVEN, CT 06516 | $111K |
| LORI FREDETTE EMPLOYEE | Employee (plan) Service code 30 | 435 CAPTAIN THOMAS BOULEVARD WEST HAVEN, CT 06516 | $96K |
| DIANE KLOBUKOWSKI EXECUTIVE DIRECTOR | Employee (plan) Service code 30 | 435 CAPTAIN THOMAS BOULEVARD WEST HAVEN, CT 06516 | $88K |
| 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 | $46K |
| RICKY FREE EMPLOYEE | Employee (plan) Service code 30 | 435 CAPTAIN THOMAS BOULEVARD WEST HAVEN, CT 06516 | $39K |
| KIMBERLY MAGNANI EMPLOYEE | Employee (plan) Service code 30 | 435 CAPTAIN THOMAS BOULEVARD WEST HAVEN, CT 06516 | $37K |
| DENISE MONTESANTO EMPLOYEE | Employee (plan) Service code 30 | 435 CAPTAIN THOMAS BOULEVARD WEST HAVEN, CT 06516 | $34K |
| HOPE DACEY EMPLOYEE | Employee (plan) Service code 30 | 435 CAPTAIN THOMAS BOULEVARD WEST HAVEN, CT 06516 | $32K |
| T.M. BYXBEE CO. EIN 06-1386456 ACCOUNTANT | Accounting (including auditing) Service code 10 | 2319 WHITNEY AVE HAMDEN, CT 06518 | $31K |
| ALDA RUZICKA EMPLOYEE | Employee (plan) Service code 30 | 435 CAPTAIN THOMAS BOULEVARD WEST HAVEN, CT 06516 | $28K |
| SEGAL MARCO ADVISORS EIN 13-2646110 INVESTMENT ADVISOR | Investment advisory (plan) Service code 27 | 333 WEST 34TH STREET NEW YORK, NY 100012402 | $24K |
| DAVIS VISION EIN 11-3051991 VISION BENEFITS ADMINISTR | Contract Administrator Service code 13 | 175 E. HOUSTON STREET 5TH FLOOR SAN ANTONIO, TX 78205 | $24K |
| CVS PHARMACY, INC. EIN 05-0340626 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $17K |
| PRINCIPAL CUSTODIAL SOLUTIONS EIN 42-1520346 INVESTMENT CUSTODIAN | Custodial (other than securities); Custodial (securities) Service code 18 | 222 SOUTH 9TH ST, STE 1400 MINNEAPOLIS, MN 55402 | $7K |
| 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 | $4K |
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 | 2,549 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,435 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 3,984 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE AND ACCIDENT | 3,155 | $174K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 2,725 | $847K |
| Other | HARTFORD LIFE AND ACCIDENT | 2,417 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,155 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.