Form 5500 · Employee benefit plan · FAIRLAWN, NJ
ULMA FORM WORKS, INC
The filing calls this plan ULMA FORM WORKS BENEFIT PLAN.
Public Form 5500 records show how ULMA FORM WORKS, INC of FAIRLAWN, NJ, a real estate employer, structures its employee benefits. Its broker of record is ALTOMARE FINANCIAL GROUP INC. Coverage is written through HORIZON HEALTHCARE SERVICES, INC. and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 22-3617107 · plan 501 · plan year 2025, filed Jul 15, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: death benefits.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 3 insured contracts covering health, dental, vision, life and disability; the largest, with HORIZON HEALTHCARE SERVICES, INC., covers 77 people.
Reported premium across the insured contracts is $1,815,922, with $93,352 in disclosed broker commissions — about 5.1% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
ALTOMARE FINANCIAL GROUP INC is the broker of record on 1 of the 3 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including HORIZON HEALTHCARE SERVICES, INC., PRINCIPAL LIFE INSURANCE COMPANY and VISION SERVICE PLAN. HORIZON HEALTHCARE SERVICES, INC. writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| HORIZON HEALTHCARE SERVICES, INC. | Health | 77 | Jan 1, 2026 | $1,618,829 | $78,513 |
| PRINCIPAL LIFE INSURANCE COMPANY | Health, Dental, Life, Disability | 205 | Jan 1, 2026 | $184,889 | $13,405 |
| VISION SERVICE PLAN | Vision | 80 | Jan 1, 2026 | $12,204 | $1,434 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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