| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE Filed as: LAKESHORE BENEFIT GROUP INS. BROKER | PO BOX 670 NEW HARTFORD, CT 06057 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $10K | — | $10K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE COMP EIN 59-1031071 NONE | Named fiduciary; Direct payment from the plan; Other services; Participant communication; Float revenue; Contract Administrator; Investment management fees paid indirectly by plan; Claims processing; Non-monetary compensation Service code 12 | 5089 COLLECTION CENTER DRIVE CHICAGO, IL 60693 | $154K |
| CARDAY ASSOCIATES EIN 53-0257019 NONE | Direct payment from the plan; Contract Administrator Service code 13 | 7130 COLUMBIA GATEWAY DRIVE STE A COLUMBIA, MD 21046 | $132K |
| LOCAL 485 IUE-CWA EIN 11-1800146 SPONSOR | Direct payment from the plan; Employee (plan sponsor) Service code 35 | 160 MONTAGUE STREET BROOKLYN, NY 11201 | $64K |
| ESTEBANIA SANTILLAN EIN 11-1800146 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 160 MONTAGUE STREET BROOKLYN, NY 11201 | $31K |
| KENNEDY, JENNIIK AND MURRAY, PC EIN 25-1919594 NONE | Legal; Direct payment from the plan Service code 29 | 113 UNIVERSITY PLACE NEW YORK, NY 10003 | $30K |
| BASIL CASTROVINCI, INC. EIN 13-2831500 NONE | Actuarial; Direct payment from the plan Service code 11 | 36 HOPATCHUNG ROAD HOPATCONG, NJ 07843 | $28K |
| GITOMER & BERENHOLZ EIN 23-2749598 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | 445 SHADY LANE HUNTINGDON VALLEY, PA 19006 | $21K |
| INVESTMENT PERFORMANCE SERVICE EIN 58-1645832 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | 7402 HODGSON MEMORIAL DRIVE SUITE 100 SAVANNAH, GA 31406 | $9K |
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 | 223 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | FIDELITY SECURITY LIFE INSURANCE COMPANY | 223 | $102K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 223 | — |
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.
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.