| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAPACITY BENEFITS & FINANCIAL SERVI3 Filed as: CAPACITY BENEFITS GROUP, INC. | ONE INTERNATIONAL BLVD MAHWAH, NJ 07495 | DELTA DENTAL OF NJ, INC. | $3K | — | $3K | 5.53% |
| CAPACITY BENEFITS & FINANCIAL SERVI3 Filed as: CAPACITY BENEFITS GROUP, INC. | 1 INTERNATIONAL BLVD. STE 340 MAHWAH, NJ 07495 | VISION SERVICE PLAN | $849 | — | $849 | 6.37% |
| CAPACITY BENEFITS & FINANCIAL SERVI3 Filed as: CAPACITY BENEFITS GROUP, INC. | 1 INTERNATIONAL BLVD. MAHWAH, NJ 07495 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 13.86% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS. SERVICES | P.O. BOX 28 DUBUQUE, IA 52004 | HARTFORD LIFE AND ACCIDENT | $141 | — | $141 | 1.25% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS & FINANCIAL | 4851 LBJ FREEWAY STE 100 DALLAS, TX 75244 | HARTFORD LIFE AND ACCIDENT | — | $41 | $41 | 0.36% |
| CAPACITY BENEFITS & FINANCIAL SERV3 Filed as: CAPACITY BENEFIFTS & FINANCIAL SVCS | GRP ONE INTERNATIONAL BLVD MAHWAH, NJ 07495 | FIDELITY LIFE INSURANCE | $1K | — | $1K | 9.55% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KEY BENEFIT ADMINISTRATORS, INC. EIN 35-1450364 THIRD-PARTY ADMINISTRATOR | Other services; Plan Administrator; Insurance brokerage commissions and fees Service code 14 | — | $37K |
| AMERICAN HEALTH DATA INSTITUTE EIN 35-2048379 THIRD-PARTY ADMINISTRATOR | Other services; Insurance brokerage commissions and fees; Plan Administrator Service code 14 | — | $9K |
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 | 171 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 171 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NJ, INC. | 171 | $52K |
| Vision | VISION SERVICE PLAN | 152 | $13K |
| Life insurance(3 contracts, 3 carriers) | COMPANION LIFE INSURANCE | 73 | $57K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 38 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 171 | — |
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.