| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMWINS5 | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | UNITED AMERICAN INSURANCE COMPANY | — | $15K | $15K | 6.86% |
| STUART HILTON GROVE3 | 5 LANCELOT WAY HAMDEN, CT 06518 | THE HARTFORD | $13K | — | $13K | 8.00% |
| STUART HILTON GROVE3 | 5 LANCELOT WAY HAMDEN, CT 06518 | CVS PHARMACY, INC | $2K | — | $2K | 12.57% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AMWINS EIN 05-0461576 NONE | Insurance agents and brokers Service code 22 | — | $223K |
| HARTFORD LIFE & ACCIDENT INS. CO. EIN 06-0838648 NONE | Insurance services Service code 23 | — | $168K |
| NORTHERN TRUST EIN 36-1561860 NONE | Trustee (directed) Service code 25 | — | $41K |
| CVS PHARMACY, INC EIN 05-0340626 NONE | Insurance services Service code 23 | — | $18K |
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 | 3 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 123 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED AMERICAN INSURANCE COMPANY | 101 | $223K |
| Life insurance | THE HARTFORD | 94 | $168K |
| Prescription drug | CVS PHARMACY, INC | 25 | $18K |
| Other | THE HARTFORD | 94 | $168K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 101 | — |
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.