| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PENTRA LLC3 Filed as: PENTRA | 795 E LANCASTER AVE #210 VILLANOVA, PA 19085 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $14K | $0 | $14K | 10.00% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $0 | $5K | $5K | 4.00% |
| PENTRA LLC3 Filed as: PENTRA | 795 E LANCASTER AVE 2 VILLANOVA CTR # 210 VILLANOVA, PA 19085 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $7K | $1K | $8K | 11.64% |
| LAMOTTE, NICHOLAS3 | 795 E. LANCASTER AVE. SUITE 210 VILLANOVA, PA 19085 | AETNA LIFE INSURANCE COMPANY | $6K | $0 | $6K | 10.00% |
| PENTRA LLC3 Filed as: PENTRA | 795 E LANCASTER AVE 2 VILLANOVA CTR # 210 VILLANOVA, PA 19085 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $4K | $510 | $4K | 11.33% |
| LAMOTTE, NICHOLAS3 | 795 E. LANCASTER AVE. SUITE 210 VILLANOVA, PA 19085 | AETNA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 10.00% |
| PENTRA LLC3 Filed as: PENTRA | 795 E LANCASTER AVE 2 VILLANOVA CTR # 210 VILLANOVA, PA 19085 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $973 | $127 | $1K | 11.31% |
| NICHOLAS H. LAMOTTE3 | 795 E LANCASTER AVE #210 VILLANOVA, PA 19085 | FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK | $1K | $0 | $1K | 13.22% |
| PENTRA LLC3 Filed as: PENTRA | 795 E LANCASTER AVE 2 VILLANOVA CTR # 210 VILLANOVA, PA 19085 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $623 | $93 | $716 | 11.49% |
| NICHOLAS H. LAMOTTE3 | 795 E LANCASTER AVE #210 VILLANOVA, PA 19085 | FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK | $339 | $0 | $339 | 13.23% |
| NICHOLAS H. LAMOTTE3 | 795 E LANCASTER AVE #210 VILLANOVA, PA 19085 | FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK | $151 | $0 | $151 | 13.22% |
| PENTRA LLC3 Filed as: PENTRA | 795 E LANCASTER AVE 2 VILLANOVA CTR # 210 VILLANOVA, PA 19085 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $68 | $24 | $92 | 12.55% |
| NICHOLAS H. LAMOTTE3 | 795 E LANCASTER AVE #210 VILLANOVA, PA 19085 | FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK | $95 | $0 | $95 | 13.23% |
| NICHOLAS H. LAMOTTE3 | 795 E LANCASTER AVE #210 VILLANOVA, PA 19085 | FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK | $56 | $0 | $56 | 13.15% |
| NICHOLAS H. LAMOTTE3 | 795 E LANCASTER AVE #210 VILLANOVA, PA 19085 | FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK | $5 | $0 | $5 | 13.16% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 NONE | Contract Administrator; Claims processing Service code 12 | — | $154K |
| PENTRA NONE | Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | TWO VILLANOVA CENTER 795 E. LANCASTER AVENUE SUITE 210 VILLANOVA, PA 19085 | $89K |
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 | 101 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 164 | $810K |
| Dental(3 contracts, 2 carriers) | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 93 | $229K |
| Vision(8 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 147 | $105K |
| Life insurance | CIGNA LIFE INSURANCE CO. OF NEW YORK | 169 | $72K |
| Short-term disability(2 contracts) | CIGNA LIFE INSURANCE CO. OF NEW YORK | 65 | $7K |
| Long-term disability | CIGNA LIFE INSURANCE CO. OF NEW YORK | 101 | $38K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 164 | $718K |
| Other(2 contracts) | CIGNA LIFE INSURANCE CO. OF NEW YORK | 169 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 169 | — |
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.