| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FIDELITY HEALTH INSURANCE SERVICES3 | 26 NELSON ST KINGSTON, MA 02364 | PROVIDENCE HEALTH PLAN | $134K | — | $134K | 5.00% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $33 | $0 | $33 | 0.01% |
| FIDELITY HEALTH INSURANCE SERVICES3 | 200 SEAPORT BLVD BOSTON, MA 02210 | PACIFICSOURCE HEALTH PLANS | $10K | — | $10K | 4.94% |
| FIDELITY HEALTH INSURANCE SERVICES3 | 200 SEAPORT BLVD BOSTON, MA 02210 | VISION SERVICE PLAN | $1K | — | $1K | 4.58% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRUDENTIAL EIN 22-1211670 CONTRACT ADMIN FEES | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $7K |
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 | 149 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 153 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PROVIDENCE HEALTH PLAN | 388 | $2.9M |
| Dental | PACIFICSOURCE HEALTH PLANS | 383 | $196K |
| Vision | VISION SERVICE PLAN | 109 | $23K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 199 | $585K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 199 | $585K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 199 | $585K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 388 | $2.7M |
| Other(4 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 199 | $600K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 388 | — |
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."
No prospect flags tripped on this filing.