| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RSC INSURANCE BROKERAGE INC3 | 160 FEDERAL STREET 2ND FLOOR BOSTON, MA 02110 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $14K | $0 | $14K | 5.00% |
| RSC INSURANCE BROKERAGE INC3 | 160 FEDERAL ST 4TH FLOOR BOSTON, MA 02110 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $11K | $0 | $11K | 3.92% |
| VARIOUS - SEE ATTACHED3 Filed as: VARIOUS BROKERS (LIST ATTACHED) | — | MASS MUTUAL LIFE INSURANCE COMPANY | $40K | $0 | $40K | 40.07% |
| VARIOUS - SEE ATTACHED4 Filed as: VARIOUS BROKERS (LIST ATTACHED) | — | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $811 | $0 | $811 | 6.83% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVE HARTFORD, CT 06156 | $1.5M |
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 | 816 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 19 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 23 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 858 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 816 | $383K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 816 | $282K |
| Stop-loss / reinsurancereinsurance | GRANULAR INSURANCE COMPANY | 1,353 | $1.5M |
| Other(3 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 816 | $294K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,353 | — |
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.