| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EPIC3 Filed as: EPIC COOK MARAN | 40 MARCUS DRIVE 3RD FLOOR MELVILLE, NY 11747 | DELTA DENTAL OF NEW JERSEY, INC. | $2K | $0 | $2K | 4.28% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS. & FINANCIAL | SERVICES 1133 WESTCHESTER AVE WHITE PLAINS, NY 10604 | DELTA DENTAL OF NEW JERSEY, INC. | $2K | $0 | $2K | 4.15% |
| SEE ATTACHED3 | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11K | $6K | $17K | 42.93% |
| EPIC3 Filed as: EPIC COOK MARAN | 40 MARCUS DRIVE 3RD FLOOR MELVILLE, NY 11747 | DELTA DENTAL OF CONNECTICUT, INC. | $474 | $0 | $474 | 4.37% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS. & FINANCIAL | SERVICES 1133 WESTCHESTER AVE WHITE PLAINS, NY 10604 | DELTA DENTAL OF CONNECTICUT, INC. | $460 | $0 | $460 | 4.24% |
| SEE ATTACHED3 | — | PAUL REVERE LIFE INSURANCE COMPANY | $2K | $3K | $5K | 71.59% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 Filed as: EDGEWOOD PARTNERS INS CENTER | 14 HACKAMORE LANE BELL CANYON, CA 91307 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $127 | $68 | $195 | 12.60% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS. & FINANCIAL | SERVICES 1133 WESTCHESTER AVE WHITE PLAINS, NY 10604 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $77 | $77 | 4.97% |
| MARSH & MCLENNAN AGENCY LLC3 | PO BOX 350 CONSHOHOCKEN, PA 19428 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $28 | $0 | $28 | 1.81% |
No Schedule C service providers reported on this filing.
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 | 118 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 119 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NEW JERSEY, INC. | 82 | $50K |
| Vision | DELTA DENTAL OF CONNECTICUT, INC. | 85 | $11K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 124 | $2K |
| Other(3 contracts, 3 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 124 | $47K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 124 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.