| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PIERSON & SMITH, INC.3 | 40 RICHARDS AVENUE NORWALK, CT 06854 | ANTHEM HEALTH PLANS OF CONNECTICUT, INC. | $12K | — | $12K | 5.00% |
| FIRST NIAGARA RISK MANAGEMENT3 Filed as: FIRST NIAGARA RISK MANAGEMENT, INC. | 555 PATROON CREEK BLVD. ALBANY, NY 12206 | ANTHEM LIFE INSURANCE COMPANY | $5K | — | $5K | 3.32% |
| FIRST NIAGARA RISK MANAGEMENT3 | 555 PATROON CREEK BLVD. ALBANY, NY 12206 | ANTHEM BLUE CROSS & BLUE SHIELD | $16K | — | $16K | 72.09% |
| PIERSON & SMITH, INC.3 | P.O. BOX 1266 DARIEN, CT 06820 | HARTFORD LIFE AND ACCIDENT | $3K | $277 | $3K | 16.42% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO. EIN 59-1031071 | Claims processing; Non-monetary compensation; Direct payment from the plan; Float revenue; Participant communication; Other services; Contract Administrator; Named fiduciary Service code 12 | 280 TRUMBULL ST HARTFORD, CT 06152 | $245K |
| FIRST NIAGARA RISK MANAGEMENT BROKER | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 555 PLATROON CREEK BLVD ALBANY, NY 12206 | $70K |
| ANTHEM LIFE INSURANCE (G1400) EIN 35-0980405 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing; Contract Administrator; Other services Service code 12 | 1351 WM HOWARD TAFT RD CINCINNATI, OH 452061721 | $6K |
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 | 362 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 362 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | ANTHEM HEALTH PLANS OF CONNECTICUT, INC. | 280 | $245K |
| Vision | ANTHEM BLUE CROSS & BLUE SHIELD | 333 | $22K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 360 | $150K |
| Short-term disability | ANTHEM LIFE INSURANCE COMPANY | 360 | $150K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 360 | $150K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH & LIFE INSURANCE COMPANY | 563 | $435K |
| Other | HARTFORD LIFE AND ACCIDENT | 362 | $20K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 563 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.