| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INSURANCE SERV. LLC | 245 SUMMER STREET BOSTON, MA 02210 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $74K | $74K | 4.96% |
| FIDELITY HEALTH INSURANCE SERVICES3 | 245 SUMMER STREET BOSTON, MA 02210 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $12K | — | $12K | 7.38% |
| CIS INSURANCE & INVESTMENTS3 | 550 S 5TH ST UNIT 303 LOUISVILLE, KY 40202 | HUMANA HEALTH PLAN, INC. | $3K | $256 | $3K | 4.33% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 CONTRACT ADMIN FEES | Contract Administrator; Claims processing Service code 12 | — | $206K |
| ROSCOMMON INSURANCE COMPANY EIN 83-2581359 CONTRACT ADMIN FEES | Contract Administrator; Claims processing Service code 12 | — | $82K |
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 | 683 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 683 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 180 | $1.6M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 180 | $1.5M |
| Life insurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 683 | $163K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 683 | $163K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 180 | $1.5M |
| Other | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 683 | $163K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 683 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.