| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EJA/CAPACITY BENEFITS AGENCY, LLC3 Filed as: EJA/CAPACITY BENEFITS AGENCY LLC | 217 ROUTE 130 BORDENTOWN, NJ 08505 | DELTA DENTAL OF NEW JERSEY INC | $6K | — | $6K | 3.36% |
| EJA/CAPACITY BENEFITS AGENCY, LLC3 Filed as: EJA/CAPACITY BENEFITS AGE | 217 US HIGHWAY 130 BORDENTOWN, NJ 08505 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 5.38% |
| SAVOY ASSOCIATES3 | 258 HANOVER ROAD SUITE 220 FLORHAM PARK, NJ 07932 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $4K | $4K | 4.27% |
| EJA/CAPACITY BENEFITS AGENCY, LLC3 Filed as: EJA/CAPACITY BENEFITS AGE | 217 US HIGHWAY 130 BORDENTOWN, NJ 08505 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 5.40% |
| SAVOY ASSOCIATES3 | 258 HANOVER ROAD SUITE 220 FLORHAM PARK, NJ 07932 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $3K | $3K | 4.29% |
| EJA/CAPACITY BENEFITS AGENCY, LLC3 Filed as: EJA CAPACITY BENEFITS AGE | 217 US HIGHWAY 130 BORDENTOWN, NJ 08505 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 7.29% |
| SAVOY ASSOCIATES3 | 258 HANOVER ROAD SUITE 220 FLORHAM PARK, NJ 07932 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1K | $1K | 4.28% |
| EJA/CAPACITY BENEFITS AGENCY, LLC3 Filed as: EJA CAPACITY INSURANCE AGENCY LLC | 217 US HIGHWAY 130 BORDENTOWN, NJ 08505 | VISION SERVICE PLAN | $1K | — | $1K | 5.82% |
| EJA/CAPACITY BENEFITS AGENCY, LLC3 Filed as: EJA/CAPACITY BENEFITS AGE | 217 US HIGHWAY 130 BORDENTOWN, NJ 08505 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 15.00% |
| SAVOY ASSOCIATES3 | 258 HANOVER ROAD SUITE 220 FLORHAM PARK, NJ 07932 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $410 | $410 | 4.99% |
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER-TIFFANY BENE CO | 400 BERWYN PARK SUITE 200 899 CASSATT ROAD BERWYN, PA 19312 | HARTFORD LIFE AND ACCIDENT | $112 | $41 | $153 | 20.40% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE LOOMIS COMPANY CLAIMS ADMIN | Claims processing; Plan Administrator; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 850 N PARK ROAD P O BOX 7011 WYOMISSING, PA 19610 | $256K |
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 | 133 | 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) | 133 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NEW JERSEY INC | 355 | $165K |
| Vision | VISION SERVICE PLAN | 129 | $17K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 205 | $65K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 206 | $30K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 206 | $88K |
| Stop-loss / reinsurancereinsurance | FIDELITY SECURITY LIFE INSURANCE COMPANY | 133 | $620K |
| Other(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 205 | $74K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 355 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.