| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLUE BACK, LLC3 Filed as: BLUE BACK HEALTH, LLC | 20 WESTERN BLVD GLASTONBURY, CT 06033 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $33K | $33K | 6.75% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2 ENTERPRISE DRIVE - SUITE 204 SHELTON, CT 06484 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $15K | $0 | $15K | 3.01% |
| BLUE BACK, LLC Filed as: BLUE BACK HEALTH, LLC | 20 WESTERN BLVD GLASTONBURY, CT 06033 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 6.55% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2 ENTERPRISE DRIVE - SUITE 204 SHELTON, CT 06484 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | $0 | $2K | $2K | 5.00% |
| SETH KALKSTEIN3 Filed as: SETH J KALKSTEIN | 67 CAPTAINS DRIVE WESTBROOK, CT 06498 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 4.78% |
| E P AMATA3 | 153 CORNERSTONE DRIVE SOUTH WINDSOR, CT 06074 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 4.78% |
| CFS HARTFORD LLC3 | 29 SOUTH MAIN STREET WEST HARTFORD, CT 06107 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $34 | — | $34 | 0.10% |
| SETH JASON KALKSTEIN3 | 29 SOUTH MAIN STREET SUITE 201 WEST HARTFORD, CT 06107 | NORTHWESTERN MUTUAL | $2K | $464 | $2K | 7.17% |
| PAUL GLOBAL BENEFITS INC3 Filed as: E PAUL AMATA | 29 S MAIN ST STE 201 WEST HARTFORD, CT 06107 | NORTHWESTERN MUTUAL | $2K | $464 | $2K | 7.17% |
| PIZZUITI GROUP LLC3 | 29 SOUTH MAIN STREET SUITE 201 WEST HARTFORD, CT 06107 | NORTHWESTERN MUTUAL | $737 | $88 | $825 | 2.57% |
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 | 105 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 102 | $491K |
| Dental | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 72 | $50K |
| Vision | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 72 | $50K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 105 | $35K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 105 | $35K |
| Long-term disability | NORTHWESTERN MUTUAL | 108 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 108 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.