| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP INSURANCE B | 529 MAIN STREET SUITE 2B NEW HARTFORD, CT 060570000 | GERBER LIFE INSURANCE COMPANY | $10K | — | $10K | 5.00% |
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GRP INS BROKERAGE | PO BOX 670 NEW HARTFORD, CT 060570000 | METROPOLITAN LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| I.E. SHAFFER & CO. EIN 22-1750854 NONE | Contract Administrator Service code 13 | — | $281K |
| HORIZON BLUE CROSS BLUE SHIELD OF N NONE | Claims processing; Contract Administrator Service code 12 | 3 PENN PLAZA EAST, PP-04V NEWARK, NJ 07105 | $256K |
| MSPC CERTIFIED PUBLIC ACCOUNTANTS EIN 22-2951202 NONE | Accounting (including auditing) Service code 10 | — | $90K |
| O BRIEN, BELLAND & BUSHINSKY LLC EIN 37-1467056 NONE | Legal Service code 29 | — | $70K |
| LINDABURY, MCCORMICK, ESTABROOK EIN 22-1943351 NONE | Legal Service code 29 | — | $45K |
| WEAVER C. BARKSDALE EIN 62-1217255 NONE | Investment advisory (plan) Service code 27 | — | $19K |
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 | 535 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 228 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 763 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 0 | $23K |
| Stop-loss / reinsurancereinsurance | GERBER LIFE INSURANCE COMPANY | 625 | $196K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 0 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 625 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.