| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INSURANCE SERV. LLC | 200 SEAPORT BLVD V2B BOSTON, MA 02210 | AETNA LIFE INSURANCE CO. | $70K | — | $70K | 2.66% |
| THE GRAHAM COMPANY3 | ONE PENN SQUARE WEST PHILADELPHIA, PA 19102 | AETNA LIFE INSURANCE CO. | $26K | — | $26K | 1.00% |
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INSURANCE | 200 SEAPORT BLVD MAIL ZONE V2B BOSTON, MA 02210 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $3K | $663 | $3K | 7.85% |
| THE GRAHAM COMPANY3 | 30 SOUTH 15TH ST 23RD FL PHILADELPHIA, PA 08054 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $510 | — | $510 | 1.26% |
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INSURANCE | 200 SEAPORT BLVD MAIL ZONE V2B BOSTON, MA 02210 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $2K | $353 | $2K | 12.37% |
| THE GRAHAM COMPANY3 | 30 SOUTH 15TH ST 23RD FL PHILADELPHIA, PA 19102 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $633 | — | $633 | 3.19% |
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INSURANCE | 200 SEAPORT BLVD MAIL ZONE V2B BOSTON, MA 02210 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $705 | $163 | $868 | 9.46% |
| THE GRAHAM COMPANY3 | 30 SOUTH 15TH ST 23RD FL PHILADELPHIA, PA 19102 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $212 | — | $212 | 2.31% |
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INSURANCE | 200 SEAPORT BLVD, MAIL ZONE V2D BOSTON, MA 02210 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $369 | $61 | $430 | 10.50% |
| THE GRAHAM COMPANY3 | 30 SOUTH 15TH ST 23RD FL PHILADELPHIA, PA 19102 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $123 | — | $123 | 3.00% |
No Schedule C service providers reported on this filing.
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 | 209 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 211 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 330 | $2.7M |
| Dental | AETNA LIFE INSURANCE CO. | 330 | $2.6M |
| Vision | AETNA LIFE INSURANCE CO. | 330 | $2.6M |
| Life insurance | CIGNA LIFE INSURANCE CO. OF NEW YORK | 247 | $40K |
| Short-term disability | CIGNA LIFE INSURANCE CO. OF NEW YORK | 15 | $9K |
| Long-term disability | CIGNA LIFE INSURANCE CO. OF NEW YORK | 20 | $20K |
| Other | CIGNA LIFE INSURANCE CO. OF NEW YORK | 209 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 330 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.