| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 | 529 MAIN ST STE 2B THE CORNER HOUSE NEW HARTFORD, CT 06057 | GERBER LIFE INSURANCE COMPANY | $57K | — | $57K | 12.00% |
| LAKESHORE BENEFIT GROUP INSURANCE3 | 529 MAIN ST STE 2B THE CORNER HOUSE NEW HARTFORD, CT 06057 | AETNA LIFE INSURANCE CO | $6K | — | $6K | 14.94% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| I.E. SHAFFER & CO. EIN 22-1750854 NONE | Contract Administrator Service code 13 | 830 BEAR TAVERN ROAD, PO BOX 1028 WEST TRENTON, NJ 08628 | $269K |
| AETNA LIFE INSURANCE CO EIN 06-6033492 NONE | Contract Administrator Service code 13 | 151 FARMINGTON AVENUE HARTFORD, CT 06103 | $260K |
| DELTA DENTAL OF NJ EIN 22-1896118 NONE | Other services Service code 49 | — | $50K |
| ENVISION EIN 05-0570786 NONE | Other services Service code 49 | — | $38K |
| PRINCETON HEALTHCARE SYSTEM EAP EIN 21-0635009 NONE | Other services Service code 49 | 1000 HERRONTOWN ROAD, CLOCK BLDG PRINCETON, NJ 08540 | $29K |
| MSPC CERTIFIED PUBLIC ACCOUNTANTS EIN 22-2951202 NONE | Accounting (including auditing) Service code 10 | 340 NORTH AVE EAST CRANFORD, NJ 07016 | $16K |
| PFM ASSET MANAGEMENT, LLC EIN 23-3087064 NONE | Investment management Service code 28 | TWO LOGAN SQUARE, SUITE 1600 PHILADELPHIA, PA 19103 | $10K |
| ORANSKY, SCARAGGI , BORG & ABBAMON, EIN 22-2221479 NONE | Legal Service code 29 | P O BOX 866 WEST CALDWELL, NJ 070070866 | $9K |
| VANGUARD INSTITUTIONAL INVESTOR SER EIN 13-1423090 NONE | Investment management Service code 28 | P O BOX 7800 PHILADELPHIA, PA 19101 | $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 | 803 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 236 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,039 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NJ, INC | 1,039 | $962K |
| Life insurance | AETNA LIFE INSURANCE CO | 1,039 | $37K |
| Stop-loss / reinsurancereinsurance | GERBER LIFE INSURANCE COMPANY | 1,039 | $473K |
| Other | AETNA LIFE INSURANCE CO | 1,039 | $37K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,039 | — |
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.