| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP INSURANCE B | 529 MAIN ST STE 2B THE CORNER HOUSE NEW HARTFORD, CT 06057 | AETNA LIFE INSURANCE COMPANY AND AFFILIATES | $29K | — | $29K | 10.02% |
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP INSURANCE B | 529 MAIN ST STE 2B THE CORNER HOUSE NEW HARTFORD, CT 06057 | AETNA LIFE INSURANCE COMPANY AND AFFILIATES | $8K | — | $8K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| I.E. SHAFFER & CO. EIN 22-1750854 NONE | Contract Administrator Service code 13 | — | $479K |
| UBS FINANCIAL SERVICES EIN 13-2638166 NONE | Custodial (securities) Service code 19 | — | $101K |
| ENVISION EIN 05-0570786 NONE | Contract Administrator Service code 13 | — | $61K |
| RYAN LABS INC. EIN 13-3451974 NONE | Investment management Service code 28 | — | $60K |
| PRINCETON HEALTHCARE SYSTEMS EIN 21-0635009 NONE | Other services Service code 49 | 1000 HERRONTOWN RD CLOCK BLDG. PRINCETON, NJ 08540 | $42K |
| NGAM ADVISORS, L.P. EIN 04-3274056 NONE | Investment management Service code 28 | — | $38K |
| BAHL & GAYNOR EIN 31-1297139 NONE | Investment management Service code 28 | — | $36K |
| KROLL & HEINEMAN EIN 22-2897879 NONE | Legal Service code 29 | — | $29K |
| MANNING & NAPIER EIN 45-3328488 NONE | Investment management Service code 28 | — | $27K |
| MSPC CERTIFIED PUBLIC ACCOUNTANTS EIN 22-2951202 NONE | Accounting (including auditing) Service code 10 | — | $27K |
| LINDABURY, MCCORMICK EIN 22-1943351 NONE | Legal Service code 29 | — | $24K |
| VIANT PAYMENT SYSTEMS EIN 36-3715258 NONE | Contract Administrator Service code 13 | — | $18K |
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 | 817 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 410 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,227 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AETNA LIFE INSURANCE COMPANY AND AFFILIATES | 823 | $50K |
| Stop-loss / reinsurancereinsurance | AETNA LIFE INSURANCE COMPANY AND AFFILIATES | 942 | $287K |
| Other | AETNA LIFE INSURANCE COMPANY AND AFFILIATES | 823 | $50K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 942 | — |
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.