| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GRP INS BROKERAGE | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILATES | $2K | — | $2K | 5.52% |
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GRP INS BROKERAGE | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 5.00% |
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GRP INS BROKERAGE | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ASSOCIATED ADMINISTRATORS, LLC EIN 65-1205077 NONE | Plan Administrator; Direct payment from the plan Service code 14 | — | $120K |
| WITHUMSMITH+BROWN, P.C. EIN 22-2027092 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $15K |
| O'DONOGHUE O'DONOGHUE EIN 53-0120528 NONE | Legal; Direct payment from the plan Service code 29 | — | $11K |
| THE MCKEOGH COMPANY EIN 23-3003375 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $9K |
| PKF O'CONNER DAVIES, LLP EIN 27-1728945 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $5K |
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 | 139 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 139 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF MID-ATLANTIC STATES | 262 | $1.8M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILATES | 86 | $35K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 134 | $18K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 134 | $27K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 134 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 262 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.