| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKE SHORE BENEFIT GROUP3 | 301 ALBANY TURNPIKE CANTON, CT 06019 | SYMETRA LIFE INSURANCE COMPANY | $43K | — | $43K | 16.23% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARE SERVICES, INC EIN 22-0999690 NONE | Contract Administrator Service code 13 | — | $922K |
| I.E. SHAFFER & CO. EIN 22-1750854 NONE | Contract Administrator Service code 13 | 830 BEAR TAVERN ROAD PO BOX 1028 WEST TRENTON, NJ 08628 | $647K |
| O'BRIEN BELLAND & BUSHINSKY EIN 37-1467056 NONE | Legal Service code 29 | — | $92K |
| ENVISION RX OPTIONS EIN 05-0570786 NONE | Contract Administrator Service code 13 | — | $75K |
| PRINCETON HEALTHCARE SYSTEM EAP EIN 21-0635009 NONE | Other services Service code 49 | 1000 HERRONTOWN ROAD, CLOCK BLDG PRINCETON, NJ 08540 | $69K |
| PRUDENTIAL RETIREMENT INS. COMPANY EIN 06-1050034 NONE | Investment advisory (plan) Service code 27 | — | $49K |
| GERSON & ASSOC CPAS AND ADVISORS PC EIN 22-3163246 NONE | Accounting (including auditing) Service code 10 | 201 WEST PASSAIC STREET ROCHELLE PARK, NJ 07662 | $25K |
| MSPC CERTIFIED PUBLIC ACCOUNTANTS EIN 22-2951202 NONE | Accounting (including auditing) Service code 10 | — | $10K |
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 | 1,707 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 672 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,379 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NJ,INC. | 0 | $1.2M |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 1,760 | $267K |
| Stop-loss / reinsurancereinsurance | AMALGAMATED LIFE | 2,379 | $451K |
| Other | SYMETRA LIFE INSURANCE COMPANY | 1,760 | $267K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,379 | — |
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.