| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INSURANCE SVCS LLC | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $57K | — | $57K | 13.16% |
| FIDELITY HEALTH INSURANCE SERVICES3 | 200 BOSTON, MA 02210 | DELTA DENTAL OF MA | $7K | — | $7K | 4.54% |
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INSURANCE SERV | 200 SEAPORT BLVD BOSTON, MA 02210 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 9.12% |
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INSURANCE SER | 200 SEAPORT BLVD BOSTON, MA 02210 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 16.32% |
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INSURANCE SERVICES, | FIDELITY HEALTH INSURANCE SERVICES, BOSTON, MA 02210 | EYEMED VISION | $923 | — | $923 | 9.93% |
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INSURANCE SERVICES, | 200 SEAPORT BLVD., BOSTON, MA 02211 | EYEMED VISION | $707 | — | $707 | 10.22% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 CONTRACT ADMIN | Contract Administrator; Claims processing; Non-monetary compensation; Participant communication; Other services; Named fiduciary; Direct payment from the plan; Float revenue Service code 12 | — | $10K |
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 | 127 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 128 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 179 | $433K |
| Dental | DELTA DENTAL OF MA | 277 | $148K |
| Vision(2 contracts) | EYEMED VISION | 122 | $16K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 126 | $103K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 126 | $86K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 126 | $86K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 126 | $103K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 277 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.