| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS & FINANCIAL SERVI | 1133 WEST CHESTER AVE. WHITE PLAINS, NY 10604 | CIGNA | — | $8K | $8K | 4.95% |
| JACOBSON GOLDFARB & SCOTT INC3 | 101 CROWFORDS CORNER RD HOLMDEL, NJ 07733 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $4K | — | $4K | 5.00% |
| JACOB GOLDFARB & SIN INC3 | 101 CRAWFORD CORNER RD STE 1300 HOLMDEL, NJ 07733 | DELTA DENTAL OF NJ, INC. | $2K | — | $2K | 4.16% |
| JACOBSEON, GOLDFARB & SCOTT3 | 101 CRAWFORDS CORNER RD 1300 HOLMDEL, NJ 07733 | THE HARTFORD | — | — | $0 | 0.00% |
| JGS INSURANCE3 | 101 CRAWFORDS CORNER RD, STE 1300 HOLMDEL, NJ 07733 | EYEMED | $589 | — | $589 | 9.19% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS & FINANCIAL SERVI | 1133 WEST CHESTER AVE. WHITE PLAINS, NY 10604 | EYEMED | — | $294 | $294 | 4.59% |
| JGS INSURANCE3 | 101 CRAWFORDS CORNER RD HOLMDEL, NJ 07733 | EYEMED (COBRA) | $2 | — | $2 | 8.00% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE & FINANCIAL S | 1133 WESTCHESTER AVENUE WHITE PLAINS, NY 10604 | EYEMED (COBRA) | — | $1 | $1 | 4.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 | Direct payment from the plan; Contract Administrator; Claims processing; Named fiduciary; Float revenue; Non-monetary compensation; Other services; Participant communication Service code 12 | — | $50K |
| CENTERSTONE INSURANCE AND FINANCIAL EIN 95-4018229 SERVICE/GENERAL AGENT | Other fees Service code 99 | 1133 WESTCHESTER AVE WHITE PLAINS, NY 10604 | $0 |
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 | 247 | 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) | 247 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA | 172 | $251K |
| Dental | DELTA DENTAL OF NJ, INC. | 247 | $40K |
| Vision(2 contracts, 2 carriers) | EYEMED | 210 | $6K |
| Life insurance | THE HARTFORD | 219 | $12K |
| Long-term disability | THE HARTFORD | 219 | $12K |
| Other | THE HARTFORD | 219 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 247 | — |
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.