| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| OLSON KEVIN3 | 1901 BUTTERFIELD RD, SUITE 450 DOWNERS GROVE, IL 60515 | HARTFORD LIFE AND ACCIDENT | $53K | — | $53K | 5.78% |
| E P AMATA3 Filed as: AMATA E | 153 CORNERSTONE DR SOUTH WINDSOR, CT 06074 | HARTFORD LIFE AND ACCIDENT | $39K | — | $39K | 4.34% |
| KALKSTEIN SETH3 | 29 S MAIN ST SUITE 201 WEST HARTFORD, CT 06107 | HARTFORD LIFE AND ACCIDENT | $39K | — | $39K | 4.34% |
| AFFILIATED BENEFIT CONSULTANTS3 Filed as: AFFILIATED BENEFIT CONSULTANTS, INC | 1111 W 22ND STREET, STE. 620 OAK BROOK, IL 60523 | EYEMED VISION CARE | $7K | — | $7K | 9.93% |
| AFFILIATED BENEFIT CONSULTANTS3 | 1111 W 22ND STREET SUITE 620 OAK BROOK, IL 60523 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 10.00% |
| AFFILIATED BENEFIT CONSULTANTS3 Filed as: AFFILIATED BENEFIT CONSULTANTS, INC | 1111 W 22ND STREET, STE. 620 OAK BROOK, IL 60523 | EYEMED VISION CARE | $8 | — | $8 | 8.16% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 | Contract Administrator; Other insurance fees and expenses; Direct payment from the plan Service code 13 | — | $172K |
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 | 1,142 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,155 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 213 | $62K |
| Vision(2 contracts) | EYEMED VISION CARE | 1,273 | $70K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 1,648 | $910K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 1,648 | $910K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 1,648 | $910K |
| Stop-loss / reinsurancereinsurance | AETNA LIFE INSURANCE COMPANY | 360 | $269K |
| Other | HARTFORD LIFE AND ACCIDENT | 1,648 | $910K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,648 | — |
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.