| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMWINS3 Filed as: AMWINS GROUP BENEFITS INC | 50 WHITECAP DR NORTH KINGSTOWN, RI 02852 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $0 | $44K | $44K | 20.00% |
| AMWINS3 Filed as: AMWINS GROUP BENEFITS INC | 50 WHITECAP DR NORTH KINGSTOWN, RI 02852 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $0 | $2K | $2K | 2.00% |
| AMWINS3 Filed as: AMWINS GROUP BENEFITS INC | 50 WHITECAP DR NORTH KINGSTOWN, RI 02852 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $0 | $1K | $1K | 2.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA EIN 06-6033492 MEDICAL CLAIMS PROCESSING | Insurance services; Claims processing; Plan Administrator Service code 12 | 151 FARMINGTON AVENUE HARTFORD, CT 06156 | $111K |
| CHEIRON INC. EIN 03-4215617 CONSULTANT | Consulting (general); Actuarial Service code 11 | 8300 GREENSBORO DRIVE SUITE 800 TYSONS CORNER, VA 22102 | $37K |
| CIGNA EIN 59-1031071 DENTAL SERVICE PROVIDER | Insurance services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Account maintenance fees; Accounting (including auditing) Service code 10 | 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 | $7K |
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 | 398 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 398 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 398 | $52K |
| Short-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 398 | $219K |
| Long-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 398 | $94K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 398 | — |
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.