| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GRP INS BROKERAGE | 301 ALBANY TURNPIKE CANTON, CT 06019 | AMALGAMATED LIFE INSURANCE COMPANY | $33K | — | $33K | 5.00% |
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GRP INS BROKERAGE | 301 ALBANY TURNPIKE CANTON, CT 060192528 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | — | $6K | 14.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| I.E. SHAFFER & CO. EIN 22-1750854 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $413K |
| HORIZON HEALTHCARE SERVICES, INC. EIN 22-0999690 NONE | Direct payment from the plan; Contract Administrator; Accounting (including auditing) Service code 10 | 3 PENN PLAZA EAST, PP-04V NEWARK, NJ 07105 | $293K |
| CAPITAL RX, INC. EIN 35-2612946 NONE | Contract Administrator; Claims processing; Direct payment from the plan Service code 12 | — | $158K |
| MSPC CERTIFIED PUBLIC ACCOUNTANTS EIN 22-2951202 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $62K |
| O BRIEN, BELLAND & BUSHINSKY LLC EIN 37-1467056 NONE | Legal; Direct payment from the plan Service code 29 | — | $59K |
| LINDABURY, MCCORMICK, ESTABROOK EIN 22-1943351 NONE | Legal; Direct payment from the plan Service code 29 | — | $20K |
| FIRST ACTUARIAL CONSULTING INC. EIN 26-3842522 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $13K |
| MILLIMAN INC. EIN 91-0675641 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $10K |
| PRUDENTIAL RETIREMENT INSURANCE AND EIN 06-1050034 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $8K |
| WEAVER C. BARKSDALE EIN 62-1217255 NONE | Investment advisory (plan); Investment management fees paid directly by plan Service code 27 | — | $7K |
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 | 508 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 294 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 802 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DENTAL SERVICES ORGANIZATION, LLC | 399 | $324K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 794 | $41K |
| Stop-loss / reinsurancereinsurance | AMALGAMATED LIFE INSURANCE COMPANY | 600 | $661K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 794 | $41K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 794 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.