| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP INS BROKERA | 529 MAIN STREET STE 2B NEW HARTFORD, CT 060572111 | HCC LIFE INSURANCE COMPANY | $19K | — | $19K | 10.00% |
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP INS BROKERA | 529 MAIN ST PO BOX 670 NEW HARTFORD, CT 060572111 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 11.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTHCARE EIN 06-0303370 NONE | Named fiduciary; Float revenue; Direct payment from the plan; Other services; Participant communication; Contract Administrator; Claims processing; Non-monetary compensation Service code 12 | 5089 COLLECTION CENTER DRIVE CHICAGO, IL 60693 | $247K |
| CARDAY ASSOCIATES, INC. EIN 53-0257019 NONE | Contract Administrator; Direct payment from the plan Service code 13 | 7130 COLUMBIA GATEWAY DRIVE A COLUMBIA, MD 210462966 | $176K |
| KENNEDY, JENNIK, & MURRAY EIN 13-3849349 JENNIK MARRIED TO TRUSTEE | Legal; Direct payment from the plan Service code 29 | 113 UNIVERSITY PLACE NEW YORK, NY 10003 | $23K |
| ENVISION PHARMACEUTICAL SERVICES EIN 05-0570786 NONE | Direct payment from the plan; Claims processing Service code 12 | 2181 EAST AURORA ROAD SUITE 201 TWINSBURG, OH 44087 | $21K |
| JOHN OMEARA EIN 47-1997387 NONE | Direct payment from the plan; Trustee (individual) Service code 20 | 161 FOXWOOD DRIVE MOORESTOWN, NJ 08057 | $12K |
| GITOMER & BERENHOLZ, PC EIN 23-2749598 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | 445 SHADY LANE HUNTINGDON VALLEY, PA 19006 | $10K |
| ADMINISTRATIVE SERVICES ONLY, INC. EIN 11-2995970 NONE | Direct payment from the plan; Contract Administrator Service code 13 | 303 MERRICK ROAD 300 LYNBROOK, NY 11563 | $9K |
| CIGNA HEALTH AND LIFE INSURANCE COM | Contract Administrator; Direct payment from the plan; Other services; Named fiduciary; Claims processing; Non-monetary compensation; Participant communication; Float revenue Service code 12 | — | $0 |
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 | 533 | 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 |
|---|---|---|---|
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 549 | $24K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 519 | $194K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 549 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 549 | — |
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.