| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP INS BROKERA | 529 MAIN ST, P.O. BOX 670 NEW HARTFORD, CT 06057 | NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH | $42K | — | $42K | 9.00% |
| LAKESHORE BENEFIT GROUP INSURANCE4 Filed as: LAKESHORE BENEFIT GROUP INS BROKERA | 529 MAIN ST, P.O. BOX 670 NEW HARTFORD, CT 06057 | METROPOLITAN LIFE INSURANCE COMPANY | $9K | — | $9K | 10.11% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CARDAY ASSOCIATES, INC. EIN 53-0257019 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $355K |
| CAREFIRST BLUE CROSS/BLUE SHIELD EIN 52-1385894 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $58K |
| AMERICAN HEALTH HOLDING INC. EIN 31-1368946 NONE | Other services; Direct payment from the plan Service code 49 | — | $33K |
| HEALTHCARE STRATEGIES, INC. EIN 52-1874471 NONE | Direct payment from the plan; Other services Service code 49 | — | $24K |
| MOONEY,GREEN,SAINDON,MURPHY & WELCH EIN 52-1958229 NONE | Legal; Direct payment from the plan Service code 29 | — | $24K |
| MORGAN, LEWIS, BOCKIUS, LLP EIN 23-0891050 NONE | Direct payment from the plan Service code 50 | — | $24K |
| THE MCKEOGH COMPANY EIN 23-3003375 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $16K |
| NOVAK FRANCELLA LLC EIN 61-1436956 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $15K |
| NCAS EIN 52-0629995 NONE | Direct payment from the plan; Other services Service code 49 | — | $13K |
| GALLAGHER FIDUCIARY ADVISORS, LLC EIN 36-4291971 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $10K |
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 | 385 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 259 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 644 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 992 | $88K |
| Stop-loss / reinsurancereinsurance | NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH | 435 | $464K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 992 | $88K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 992 | — |
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.