| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE | 301 ALBANY TURNPIKE CANTON, CT 06019 | HORIZON HEALTHCARE SERVICES, INC. | $26K | — | $26K | 4.00% |
| HORIZON INSURANCE COMPANY | 3 PENN PLAZA EAST M2H NEWARK, NJ 07105 | USABLE LIFE | — | $7K | $7K | 10.14% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON EIN 22-0999690 NONE | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $483K |
| I.E. SHAFFER EIN 22-1750854 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $273K |
| UBS NONE | Direct payment from the plan; Custodial (securities) Service code 19 | 1285 AVE OF THE AMERICAS NEW YORK, NY 10019 | $263K |
| BARATZ & ASSOCIATES, P.A. NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | 4B EVES DR MARLTON, NJ 08053 | $35K |
| PAUL A. MONTALBANO, ESQ, LLC EIN 04-3669184 NONE | Legal; Direct payment from the plan Service code 29 | — | $30K |
| RAE GROUP EIN 83-4646394 NONE | Actuarial Service code 11 | — | $3K |
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 | 700 | 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) | 700 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | HORIZON INSURANCE COMPANY | 697 | $84K |
| Life insurance | USABLE LIFE | 669 | $65K |
| Stop-loss / reinsurancereinsurance | HORIZON HEALTHCARE SERVICES, INC. | 699 | $659K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 699 | — |
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.