| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE Filed as: LAKESHORE BEN GRP INS BROKERAGE LLC | 301 ALBANY TURNPIKE CANTON, CT 060192528 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | $871 | — | $871 | 1.41% |
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BEN GRP INS BROKERAGE LLC | 301 ALBANY TURNPIKE CANTON, CT 060192528 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $442 | — | $442 | 1.93% |
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BEN GRP INS BROKERAGE LLC | 301 ALBANY TURNPIKE CANTON, CT 060192528 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ASSOCIATED ADMINISTRATORS EIN 65-1205077 NONE | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Valuation (appraisals, etc.); Claims processing; Participant communication; Accounting (including auditing) Service code 10 | 911 RIDGEBROOK ROAD SPARKS, MD 21152 | $107K |
| CALIBRE CPA GROUP PLLC EIN 47-0900880 NONE | Accounting (including auditing) Service code 10 | 7501 WISCONSIN AVENUE, SUITE 1200W BETHESDA, MD 20814 | $12K |
| MOONEY, GREEN, SAINDON, MURPHY & WE NONE | Legal Service code 29 | 1920 L ST NW STE 400 WASHINGTON, DC 20036 | $9K |
| THE PHILADELPHIA TRUST COMPANY NONE | Investment management fees paid directly by plan; Investment management Service code 28 | 1760 MARKET STREET PHILADELPHIA, PA 19103 | $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 | 81 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 20 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 101 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF MID-ATLANTIC | 107 | $1.3M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 120 | $62K |
| Vision | NATIONAL VISION ADMINISTRATORS, L.L.C. | 209 | $10K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 82 | $23K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 82 | $23K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 82 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 209 | — |
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.