| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RAYANT INSURANCE AGENCY | 3 PENN PLAZA EAST NEWARK, NJ 07105 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $5K | — | $5K | 3.51% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARES SERVICES INC. EIN 22-0999690 NONE | Contract Administrator; Claims processing Service code 12 | — | $1.3M |
| WELLS FARGO ADVISORS EIN 34-1542819 NONE | Investment management fees paid directly by plan; Investment advisory (plan) Service code 27 | — | $75K |
| WASILEWSKI & KEATING P.C. EIN 22-2676761 NONE | Accounting (including auditing) Service code 10 | — | $37K |
| CHRISTOPHER RUTON EIN 22-1550500 EMPLOYEE | Employee (plan) Service code 30 | — | $35K |
| INNOVATIVE SOFTWARE SOLUTIONS EIN 23-2182079 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $34K |
| KATHLEEN IANDIORIO EIN 22-1550500 EMPLOYEE | Employee (plan) Service code 30 | — | $30K |
| VICTOR LOPEZ EIN 22-1550500 EMPLOYEE | Employee (plan) Service code 30 | — | $30K |
| SEGAL CONSULTING EIN 13-1835864 NONE | Consulting (general) Service code 16 | — | $28K |
| KIMBERLY HAMILTON EIN 22-1550500 EMPLOYEE | Employee (plan) Service code 30 | — | $27K |
| MARY ANNE WOJTAL EIN 22-1550500 EMPLOYEE | Employee (plan) Service code 30 | — | $27K |
| PATRICIA DANDOLA EIN 22-1550500 EMPLOYEE | Employee (plan) Service code 30 | — | $27K |
| CVS PHARMACY INC EIN 05-0340626 NONE | Claims processing Service code 12 | — | $21K |
| LOCAL 68 ENG UNION EDUCATION FD EIN 22-6066637 AFFILIATED FUND | Contract Administrator Service code 13 | — | $17K |
| ORANSKY SCARAGGI & BORG P.C. EIN 22-3522685 NONE | Legal Service code 29 | — | $12K |
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 | 2,157 | 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) | 2,157 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 2,157 | $143K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,157 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.