| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 | PO BOX 670 NEW HARTFORD, CT 06057 | AETNA LIFE INSURANCE CO | $2K | — | $2K | 4.99% |
| LAKESHORE BENEFIT GROUP INSURANCE3 | PO BOX 670 NEW HARTFORD, CT 06057 | 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 | Claims processing; Direct payment from the plan Service code 12 | — | $536K |
| I. E. SHAFFER & CO. EIN 22-1750854 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $169K |
| SUSANIN WIDMAN & BRENNAN, PC EIN 23-2265950 NONE | Legal; Direct payment from the plan Service code 29 | — | $45K |
| NOVAK FRANCELLA EIN 61-1436956 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $35K |
| UAW LOCAL 3170 EIN 27-5300521 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $34K |
| JOHN M. FOWLER EIN 22-3789539 TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $23K |
| CLEARY JOSEM & TRIGIANI, LLP EIN 23-2657967 NONE | Legal; Direct payment from the plan Service code 29 | — | $22K |
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 | 1,087 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,098 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | INTERNATIONAL HEALTHCARE SERVICES INC | 410 | $287K |
| Vision | HORIZON INSURANCE COMPANY | 1,098 | $116K |
| Life insurance | AETNA LIFE INSURANCE CO | 435 | $33K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 132 | $28K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 132 | $21K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 1,175 | $330K |
| Other | AETNA LIFE INSURANCE CO | 435 | $33K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,175 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.