| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP BROKERAGE, | 529 MAIN STREET SUITE 2B NEW HARTFORD, CT 06057 | GERBER LIFE INSURANCE COMPANY | $21K | — | $21K | 5.00% |
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP BROKERAGE, | PO BOX 670 NEW HARTFORD, CT 06057 | SYMETRA LIFE INSURANCE COMPANY | $678 | $0 | $678 | 4.49% |
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP BROKERAGE, | PO BOX 670 NEW HARTFORD, CT 06057 | AIG BENEFIT SOLUTIONS | — | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| IE SHAFFER & CO. EIN 22-1750854 NONE | Contract Administrator Service code 13 | — | $597K |
| PRUDENTIAL RETIREMENT INSURANCE AND EIN 06-1050034 NONE | Other investment fees and expenses Service code 72 | — | $58K |
| DAVID A. GERSON, CPA & ASSOC., PC EIN 22-3163246 NONE | Accounting (including auditing) Service code 10 | — | $38K |
| LINDABURY,MCCORMICK,ESTABROOK AND C EIN 22-1943351 NONE | Legal Service code 29 | — | $17K |
| PELLETIERI, RABSTEIN, & ALTMAN EIN 21-0533765 NONE | Legal Service code 29 | — | $16K |
| DERYDER PLANS INC. EIN 22-3082451 | Actuarial 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 | 827 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 577 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,404 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 735 | $15K |
| Stop-loss / reinsurancereinsurance | GERBER LIFE INSURANCE COMPANY | 993 | $421K |
| Other(2 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 735 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 993 | — |
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.