| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 180 PARK AVENUE, SUITE 102 FLORHAM PARK, NJ 07932 | DELTA DENTAL OF NJ INC | $6K | $0 | $6K | 3.32% |
| USI INSURANCE SERVICES LLC3 | P.O. BOX 62937 VIRGINIA BEACH, VA 234662937 | VISION SERVICE PLAN | $2K | $0 | $2K | 4.34% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 234662937 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 14.11% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARE SERVICES, INC. EIN 22-0999690 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $125K |
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 | 260 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 260 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NJ INC | 482 | $174K |
| Vision | VISION SERVICE PLAN | 207 | $35K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 260 | $28K |
| Stop-loss / reinsurancereinsurance | HORIZON HEALTHCARE SERVICES INC | 203 | $543K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 260 | $28K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 482 | — |
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.