| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP | 301 ALBANY TURNPIKE CANTON, CT 06019 | TOKIO MARINE HCC - STOP LOSS GROUP | $56K | — | $56K | 5.65% |
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP | 301 ALBANY TURNPIKE CANTON, CT 06019 | PRUDENTIAL INSURANCE COMPANY | $3K | — | $3K | 13.58% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY | — | $115 | $115 | 0.54% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARE SERVICES, INC EIN 22-0999690 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator Service code 13 | 2 PENN PLAZA EAST NEWARK, NJ 07105 | $399K |
| I E SHAFFER & CO EIN 22-1750854 NONE | Direct payment from the plan; Contract Administrator Service code 13 | PO BOX 1028 WEST TRENTON, NJ 08628 | $338K |
| CAPITAL RX, INC. EIN 35-2612946 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | 228 PARK AVENUE SOUTH NEW YORK, NY 10003 | $168K |
| LABOR FIRST LLC EIN 06-1750191 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator Service code 13 | 1000 MIDLANTIC DRIVE, SUITE 100 MOUNT LAUREL, NJ 08054 | $80K |
| GERSON & ASSOCIATES CPAS AND ADVISO EIN 22-3163246 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | 201 WEST PASSAIC STREET ROCHELLE PARK, NJ 07662 | $42K |
| PLUMBERS LOCAL UNION NO. 24 PENSION EIN 22-6042823 AFFILIATED | Contract Administrator; Direct payment from the plan Service code 13 | 20 FAIRFIELD PLACE WEST CALDWELL, NJ 07006 | $40K |
| WEAVER C BARKSDALE EIN 62-1217255 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $33K |
| BASIL CASTROVINCI ASSOCIATES EIN 13-2835100 NONE | Direct payment from the plan; Actuarial; Consulting (general) Service code 11 | 3235 KENNEDY BOULEVARD JERSEY CITY, NJ 07306 | $30K |
| AMALGAMATED BANK EIN 13-4920330 NONE | Custodial (securities); Other investment fees and expenses; Direct payment from the plan Service code 19 | 275 SEVENTH AVENUE NEW YORK, NY 10001 | $14K |
| LINDABURY, MCCORMACK & ESTABROOK EIN 22-1943351 NONE | Legal; Direct payment from the plan Service code 29 | 53 CARDINAL DRIVE WESTFIELD, NJ 07091 | $12K |
| ORANSKY, SCARAGGI, & BORG, P.C. EIN 22-3522685 NONE | Legal; Direct payment from the plan Service code 29 | 175 FAIRFIELD AVENUE WEST CALDWELL, NJ 07007 | $10K |
| MILLIMAN INC. EIN 91-0675641 NONE | Consulting (general); Direct payment from the plan Service code 16 | 17335 GOLF PARKWAY, SUITE 100 BROOKFIELD, WI 53045 | $9K |
| ZAZZALI, FAGELLA, NOWAK KLEINBAUM, EIN 22-1973215 NONE | Legal; Direct payment from the plan Service code 29 | — | $7K |
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 | 609 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 441 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,050 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | HORIZON HEALTHCARE SERVICES, INC. | 0 | $56K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY | 575 | $21K |
| Prescription drug | MEDCO CONTAINMENT LIFE INSURANCE COMPANY | 578 | $867K |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE HCC - STOP LOSS GROUP | 666 | $987K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY | 575 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 666 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.