| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 | 529 MAIN ST, STE 2B NEW HARTFORD, CT 06057 | GERBER LIFE INSURANCE COMPANY | $6K | — | $6K | 2.00% |
| LAKESHORE BENEFIT GROUP INSURANCE3 | 529 MAIN ST, STE 2B NEW HARTFORD, CT 06057 | AETNA LIFE INSURANCE CO | $2K | — | $2K | 5.12% |
| LAKESHORE BENEFIT GROUP INSURANCE3 | PO BOX 670 NEW HARTFORD, CT 060570670 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| LAKESHORE BENEFIT GROUP INSURANCE3 | PO BOX 670 NEW HARTFORD, CT 060570670 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARE SERVICES EIN 22-0999690 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $566K |
| I. E. SHAFFER & CO. EIN 22-1750854 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $174K |
| NOVAK FRANCELLA EIN 61-1436956 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $40K |
| LOCAL 3170 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | 1201 NEW ROAD LINWOOD, NJ 08221 | $38K |
| JOHN M. FOWLER EIN 22-3789539 TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $22K |
| CLEARY JOSEM & TRIGIANI, LLP EIN 23-2657967 NONE | Legal; Direct payment from the plan Service code 29 | — | $16K |
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 | 1,107 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,107 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | INTERNATIONAL HEALTHCARE SERVICES INC | 396 | $252K |
| Life insurance | AETNA LIFE INSURANCE CO | 352 | $31K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 151 | $29K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 151 | $21K |
| Stop-loss / reinsurancereinsurance | GERBER LIFE INSURANCE COMPANY | 1,258 | $304K |
| Other | AETNA LIFE INSURANCE CO | 352 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,258 | — |
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."
No prospect flags tripped on this filing.