| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INSURANCE SERV. LLC | 200 SEAPORT BLVD, MAIL ZONE V2B BOSTON, MA 02210 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $52K | — | $52K | 9.23% |
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INSURANCE SERV. LLC | 200 SEAPORT BLVD MAIL ZONE V2B BOSTON, MA 02210 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $16K | — | $16K | 9.93% |
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INSURANCE | 200 SEAPORT BLVD BOSTON, MA 02210 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 25.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 CONTRACT ADMIN FEES | Float revenue; Non-monetary compensation; Direct payment from the plan; Named fiduciary; Participant communication; Contract Administrator; Other services; Claims processing Service code 12 | — | $26K |
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 | 141 | 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) | 141 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 264 | $567K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 142 | $165K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 142 | $165K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 155 | $16K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 155 | $21K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 155 | $18K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 155 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 264 | — |
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.