| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP INS BRK LLC | 301 ALBANY TURNPIKE CANTON, CT 06019 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 5.00% |
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP INS BRK LLC | 301 ALBANY TURNPIKE CANTON, CT 06019 | 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 | — | $524K |
| I. E. SHAFFER & CO. EIN 22-1750854 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $289K |
| NOVAK FRANCELLA EIN 61-1436956 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $42K |
| JOHN M. FOWLER LLC EIN 22-3789539 TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $20K |
| CLEARY JOSEM & TRIGIANI, LLP EIN 23-2657967 NONE | Legal; Direct payment from the plan Service code 29 | — | $12K |
| MILLIMAN EIN 91-0675641 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $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 | 759 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 765 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | HORIZON HEALTHCARE SERVICES, INC. | 224 | $146K |
| Vision | HORIZON INSURANCE COMPANY | 780 | $86K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 392 | $33K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 77 | $24K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 77 | $24K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 781 | $319K |
| Other | HARTFORD LIFE AND ACCIDENT | 392 | $33K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 781 | — |
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.