| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE Filed as: LAKESHORE BENEFIT GROUP INS BRK LLC | 301 ALBANY TURNPIKE CANTON, CT 06019 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| LAKESHORE BENEFIT GROUP INSURANCE Filed as: LAKESHORE BENEFIT GROUP INS BRK LLC | 301 ALBANY TURNPIKE CANTON, CT 06019 | HARTFORD LIFE AND ACCIDENT | $1K | — | $1K | 4.61% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARE SERVICES EIN 22-0999690 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $579K |
| I. E. SHAFFER & CO. EIN 22-1750854 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $301K |
| SUSANIN WIDMAN & BRENNAN, PC EIN 23-2265950 NONE | Legal; Direct payment from the plan Service code 29 | — | $187K |
| NOVAK FRANCELLA EIN 61-1436956 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $41K |
| SEGAL NONE | Consulting (general); Direct payment from the plan Service code 16 | 333 WEST 34TH STREET NEW YORK, NY 100012402 | $28K |
| CLEARY JOSEM & TRIGIANI, LLP EIN 23-2657967 NONE | Legal; Direct payment from the plan Service code 29 | — | $25K |
| JOHN M. FOWLER LLC EIN 22-3789539 TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | — | $20K |
| UAW LOCAL 3170 EIN 27-5300521 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $17K |
| MILLIMAN NONE | Consulting (general); Direct payment from the plan Service code 16 | 1301 FIFTH AVENUE SUITE 3800 SEATTLE, WA 981012646 | $10K |
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 | 816 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 821 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(3 contracts, 3 carriers) | HORIZON HEALTHCARE SERVICES, INC. | 263 | $265K |
| Vision | HORIZON INSURANCE COMPANY | 932 | $118K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 394 | $30K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 87 | $31K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 87 | $31K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 934 | $369K |
| Other | HARTFORD LIFE AND ACCIDENT | 394 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 934 | — |
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.