| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY EMPLOYER INS SERVICES | 200 SEAPORT BLVD. BOSTON, MA 02210 | CIGNA HEALTH AND LIFE INSURANCE CO | $39K | $0 | $39K | 13.83% |
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INS. SERVICES, LLC | 200 SEAPORT BLVD. BOSTON, MA 02210 | CIGNA HEALTH AND LIFE INSURANCE CO | $14K | $0 | $14K | 4.94% |
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INS. SERVICES LLC | 200 SEAPORT BLVD BOSTON, MA 02210 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $7K | $0 | $7K | 5.26% |
| MARSH & MCLENNAN AGENCY LLC3 | P.O. BOX 85638 SAN DIEGO, CA 92186 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 1.01% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $68 | $68 | 0.05% |
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INS. SERVICES, INC | 200 SEAPORT BLVD MAILZONE V2B BOSTON, MA 02210 | DELTA DENTAL OF MASSACHUSETTS | $2K | $0 | $2K | 1.58% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 ADMIN FEES | Claims processing; Other services Service code 12 | — | $12K |
| CIGNA HEALTH & LIFE INSURANCE CO | Other services; Contract Administrator; Non-monetary compensation; Direct payment from the plan; Claims processing; Participant communication; Float revenue; Named fiduciary Service code 12 | — | $0 |
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 | 133 | 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) | 133 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE CO | 137 | $282K |
| Dental | DELTA DENTAL OF MASSACHUSETTS | 240 | $127K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE CO | 137 | $282K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 199 | $136K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 199 | $136K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 199 | $136K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 199 | $136K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 240 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.