| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKE SHORE BENEFIT GROUP3 | 301 ALBANY TURNPIKE CANTON, CT 06019 | AMALGAMATED LIFE | $62K | — | $62K | 9.00% |
| LAKESHORE BENEFIT GROUP INSURANCE3 | 529 MAIN ST STE 2B THE CORNER HOUSE NEW HARTFORD, CT 06057 | AETNA LIFE INSURANCE CO | $6K | — | $6K | 14.90% |
| 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 | $330K |
| AETNA LIFE INSURANCE CO EIN 06-6033492 NONE | Contract Administrator Service code 13 | 151 FARMINGTON AVENUE HARTFORD, CT 06103 | $318K |
| WELLDYNE RX OPTIONS NONE | Other services Service code 49 | PO BOX 90369 LAKELAND, FL 33810 | $79K |
| PELLETTIERI, RABSTEIN & ALTMAN EIN 22-2353673 NONE | Legal Service code 29 | — | $52K |
| MSPC CERTIFIED PUBLIC ACCOUNTANTS EIN 22-2951202 NONE | Accounting (including auditing) Service code 10 | 340 NORTH AVE EAST CRANFORD, NJ 07016 | $35K |
| PRINCETON HEALTHCARE SYSTEM EAP EIN 21-0635009 NONE | Other services Service code 49 | 1000 HERRONTOWN ROAD, CLOCK BLDG PRINCETON, NJ 08540 | $30K |
| VANGUARD INSTITUTIONAL INVESTOR SER EIN 13-1423090 NONE | Investment management Service code 28 | P O BOX 7800 PHILADELPHIA, PA 19101 | $17K |
| PFM ASSET MANAGEMENT, LLC EIN 23-3087064 NONE | Investment management Service code 28 | TWO LOGAN SQUARE, SUITE 1600 PHILADELPHIA, PA 19103 | $10K |
| THE MCKEOGH COMPANY NONE | Actuarial Service code 11 | 200 BARR HARBOR DR SUITE 225 WEST CONSHOHOCKEN, PA 19428 | $8K |
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 | 801 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 295 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,096 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NJ, INC | 1,096 | $968K |
| Life insurance | AETNA LIFE INSURANCE CO | 809 | $40K |
| Stop-loss / reinsurancereinsurance | AMALGAMATED LIFE | 932 | $689K |
| Other | AETNA LIFE INSURANCE CO | 809 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,096 | — |
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.