| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INSURANCE SRVCS LLC | 200 SEAPORT BLVD MAILZONE V6D BOSTON, MA 02210 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $101K | — | $101K | 2.10% |
| IMG5 | 2960 NORTH MERIDIAN ST INDIANAPOLIS, IN 46208 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $650 | $650 | 0.01% |
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY EMPLOYER SERVICES INC | 200 SEAPORT BLVD BOSTON, MA 02210 | AETNA LIFE INSURANCE COMPANY | $4K | — | $4K | 2.87% |
| FIDELITY HEALTH INSURANCE SERVICES3 | 200 SEAPORT BLVD BOSTON, MA 02210 | AETNA INTERNATIONAL | $20K | — | $20K | — |
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 | 3,435 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 602 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,037 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 16 | $142K |
| Dental | AETNA LIFE INSURANCE COMPANY | 16 | $142K |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 2,665 | $494K |
| Life insurance | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,374 | $4.8M |
| Short-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,374 | $4.8M |
| Long-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,374 | $4.8M |
| Other(2 contracts, 2 carriers) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 9,493 | $4.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 9,493 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.