| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BEN GRP INS BROKER | PO BOX 670 NEW HARTFORD, CT 060570670 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 5.37% |
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BEN GRP INS BROKER | PO BOX 670 NEW HARTFORD, CT 060570670 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $803 | — | $803 | 2.32% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ASSOCIATED ADMINISTRATORS EIN 65-1205077 | Plan Administrator Service code 14 | 911 RIDGEBROOK ROAD SPARKS, MD 21152 | $88K |
| MOONEY, GREEN, SAINDON, MURPHY&WELC EIN 52-1958229 NONE | Legal Service code 29 | 1920 L ST NW WASHINGTON, DC 20036 | $17K |
| CALIBRE CPA GROUP PLLC EIN 47-0900880 NONE | Accounting (including auditing) Service code 10 | 7501 WISCONSIN AVENUE, SUITE 1200W BETHESDA, MD 20814 | $13K |
| CAPITAL FINANCIAL, LLC NONE | Investment advisory (plan) Service code 27 | 2943 OLNEY SANDY SPRING RD, STE A OLNEY, MD 20832 | $11K |
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 | 154 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 101 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 255 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF MID-ATLANTIC | 400 | $1.9M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 209 | $77K |
| Vision | NATIONAL VISION ADMINISTRATORS, L.L.C. | 424 | $19K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 156 | $35K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 156 | $35K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 156 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 424 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.