| 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 | $96K | — | $96K | 2.28% |
| IMG5 | 2960 NORTH MERIDIAN ST INDIANAPOLIS, IN 46208 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $677 | $677 | 0.02% |
| FIDELITY HEALTH INSURANCE SERVICES3 | 200 SEAPORT BLVD 2VB BOSTON, MA 02210 | AETNA INTERNATIONAL | $20K | — | $20K | 10.56% |
| FIDELITY HEALTH INSURANCE SERVICES3 | 200 SEAPORT BLVD V2B BOSTON, MA 02210 | AETNA LIFE INSURANCE COMPANY | $2K | — | $2K | 2.97% |
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 | 3,644 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 132 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,776 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 11 | $77K |
| Dental(2 contracts, 2 carriers) | BLUECROSS BLUESHIELD OF TEXAS | 7,126 | $2.4M |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 2,740 | $439K |
| Life insurance | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,581 | $4.2M |
| Short-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,581 | $4.2M |
| Long-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,581 | $4.2M |
| Other(2 contracts, 2 carriers) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 9,123 | $4.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 9,123 | — |
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.