| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GRP INS BROKERAGE | P.O. BOX 670 NEW HARTFORD, CT 060570000 | FIDELITY SECURITY LIFE INSURANCE CO | $80K | — | $80K | 12.50% |
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GRP INS BROKERAGE | P.O. BOX 670 NEW HARTFORD, CT 060570000 | AMALGAMATED LIFE INSURANCE COMPANY | $19K | — | $19K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| I.E.SHAFFER & CO. EIN 22-1750854 NONE | Contract Administrator Service code 13 | — | $541K |
| HORIZON HEALTHCARE EIN 22-0999690 NONE | Claims processing Service code 12 | — | $462K |
| ENVISION EIN 05-0570786 NONE | Contract Administrator Service code 13 | — | $60K |
| PRUDENTIAL RETIREMENT AND ANNUITY C EIN 06-1050034 NONE | Contract Administrator Service code 13 | — | $58K |
| DAVID A. GERSON, CPA & ASSOC., PC EIN 22-3163246 NONE | Accounting (including auditing) Service code 10 | — | $48K |
| LINDABURY & ESTABROOK EIN 22-1943351 NONE | Legal Service code 29 | — | $27K |
| O'BRIEN, BELLAND,& BUSHINSKY EIN 37-1467056 NONE | Legal Service code 29 | — | $22K |
| PHARMACY OUTCOMES SPECIALISTS | Consulting (general) Service code 16 | 41 EAST MAIN STREET SUITE 200 LAKE ZURICH, IL 600470000 | $21K |
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 | 1,440 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 165 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,605 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AMALGAMATED LIFE INSURANCE COMPANY | 1,286 | $129K |
| Stop-loss / reinsurancereinsurance | FIDELITY SECURITY LIFE INSURANCE CO | 1,305 | $637K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,305 | — |
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.