| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP INC. | 529 MAIN STREET, STE 2B NEW HARTFORD, CT 06057 | GERBER LIFE INSURANCE COMPANY | $31K | — | $31K | 10.00% |
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP INC. | 529 MAIN STREET, STE 2B NEW HARTFORD, CT 06057 | PRUDENTIAL INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY | $223 | — | $223 | 1.61% |
| LAKESHORE BENEFIT GROUP INSURANCE Filed as: LAKESHORE BENEFIT GROUP INC. | 529 MAIN STREET, STE 2B NEW HARTFORD, CT 06057 | PRUDENTIAL INSURANCE COMPANY | — | — | $0 | 0.00% |
| LAKESHORE BENEFIT GROUP INSURANCE Filed as: LAKESHORE BENEFIT GROUP INC. | 529 MAIN STREET, STE 2B NEW HARTFORD, CT 06057 | PRUDENTIAL INSURANCE COMPANY | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARE SERVICES, INC EIN 22-0999690 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 2 PENN PLAZA EAST NEWARK, NJ 07105 | $307K |
| I E SHAFFER & CO EIN 22-1750854 NONE | Contract Administrator Service code 13 | PO BOX 1028 WEST TRENTON, NJ 08628 | $300K |
| PLUMBERS LOCAL UNION NO. 24 PENSION EIN 22-6042823 AFFILIATED | Contract Administrator Service code 13 | 20 FAIRFIELD PLACE WEST CALDWELL, NJ 07006 | $53K |
| ENVISION PHARMACEUTICAL SERVICES IN EIN 05-0570786 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $46K |
| DAVID A GERSON, CPA & ASSOCIATES PC EIN 22-3163246 NONE | Accounting (including auditing) Service code 10 | 201 WEST PASSAIC STREET ROCHELLE PARK, NJ 07662 | $37K |
| BASIL CASTROVINCI ASSOCIATES EIN 13-2835100 NONE | Actuarial; Consulting (general) Service code 11 | 3235 KENNEDY BOULEVARD JERSEY CITY, NJ 07306 | $27K |
| PHARMACY OUTCOMES SPECIALISTS EIN 36-4103243 NONE | Consulting (general) Service code 16 | 41 EAST MAIN ST SUITE 200 LAKE ZURICH, IL 60047 | $21K |
| WEAVER C BARKSDALE EIN 62-1217255 NONE | Investment management Service code 28 | — | $19K |
| ORANSKY, SCARAGGI, & BORG, P.C. EIN 22-3522685 NONE | Legal Service code 29 | 175 FAIRFIELD AVENUE WEST CALDWELL, NJ 07007 | $16K |
| BAHL & GAYNOR EIN 31-1297139 NONE | Investment management Service code 28 | — | $12K |
| LINDABURY, MCCORMACK & ESTABROOK EIN 22-1943351 NONE | Legal Service code 29 | 53 CARDINAL DRIVE WESTFIELD, NJ 07091 | $11K |
| ZAZZALI, FAGELLA, NOWAK KLEINBAUM, EIN 22-1973215 NONE | Legal Service code 29 | — | $9K |
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 | 622 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 513 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,135 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HORIZON HEALTHCARE SERVICES, INC. | 1,135 | $0 |
| Dental | HORIZON HEALTHCARE SERVICES, INC. | 1,135 | $120K |
| Life insurance(2 contracts) | PRUDENTIAL INSURANCE COMPANY | 609 | $26K |
| Stop-loss / reinsurancereinsurance | GERBER LIFE INSURANCE COMPANY | 1,135 | $313K |
| Other(2 contracts, 2 carriers) | HORIZON HEALTHCARE SERVICES, INC. | 1,135 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,135 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.