| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE | 301 ALBANY TURNPIKE CANTON, CT 06019 | HORIZON HEALTHCARE SERVICES, INC. | $23K | — | $23K | 3.43% |
| HORIZON INSURANCE COMPANY | 3 PENN PLAZA EAST M2H NEWARK, NJ 07105 | USABLE LIFE | $5K | — | $5K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON EIN 22-0999690 NONE | Contract Administrator; Claims processing; Direct payment from the plan Service code 12 | — | $275K |
| I.E. SHAFFER EIN 22-1750854 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $226K |
| UBS NONE | Custodial (securities); Direct payment from the plan Service code 19 | 1285 AVE OF THE AMERICAS NEW YORK, NY 10019 | $168K |
| LOCAL UNION 94 IBEW PLAN SPONSOR | Direct payment from the plan; Contract Administrator Service code 13 | 299 WARD ST FL 2 EAST WINDSOR, NJ 08520 | $66K |
| BARNETT & PATERSON, LLC EIN 83-1593573 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $26K |
| PAUL A. MONTALBANO, ESQ, LLC EIN 04-3669184 NONE | Legal; Direct payment from the plan Service code 29 | — | $25K |
| RAE GROUP EIN 83-4646394 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $5K |
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 | 763 | 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) | 763 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts) | INTERNATIONAL HEALTHCARE SERVICES, INC. | 0 | $6K |
| Life insurance | USABLE LIFE | 700 | $46K |
| Stop-loss / reinsurancereinsurance | HORIZON HEALTHCARE SERVICES, INC. | 761 | $668K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 761 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.