| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP INS BROKERA | 301 ALBANY TPKE CANTON, CT 060192528 | BERKSHIRE HATHAWAY SPECIALITY INSURANCE COMPANY | $15K | — | $15K | 8.00% |
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP INS BROKERA | 301 ALBANY TPKE CANTON, CT 060192528 | METROPOLITAN LIFE INSURANCE COMPANY | $12K | — | $12K | 9.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENESYS, INC. EIN 38-2383171 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $206K |
| ZENITH AMERICAN SOLUTIONS EIN 52-1590516 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $119K |
| MOONEY,GREEN,SAINDON,MURPHY & WELCH EIN 52-1958229 NONE | Legal; Direct payment from the plan Service code 29 | — | $103K |
| MORGAN, LEWIS, BOCKIUS, LLP EIN 23-0891050 NONE | Legal; Direct payment from the plan Service code 29 | — | $69K |
| CAREFIRST BLUE CROSS/BLUE SHIELD EIN 52-1385894 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $38K |
| AMERICAN HEALTH HOLDING INC. EIN 31-1368946 NONE | Direct payment from the plan; Other services Service code 49 | — | $29K |
| ZELIS CLAIMS INTEGRITY LLC EIN 86-1040704 NONE | Other services; Accounting (including auditing); Direct payment from the plan Service code 10 | — | $23K |
| RAE GROUP LLC EIN 83-4646394 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $21K |
| CFA, LLC DBA NCAS EIN 52-1187907 NONE | Direct payment from the plan; Other services Service code 49 | — | $16K |
| NOVAK FRANCELLA LLC EIN 61-1436956 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $16K |
| GALLAGHER FIDUCIARY ADVISORS, LLC EIN 36-4291971 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $12K |
| DOYLE PRINTING & OFFSET CO. NONE | Direct payment from the plan; Other fees Service code 50 | 5206 46TH AVE. HYATTSVILLE, MD 20781 | $7K |
| AMALGAMATED BANK EIN 13-4920330 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $1K |
| PACIFIC INCOME ADVISORS, INC. EIN 95-4067974 NONE | Investment management; Investment management fees paid indirectly by plan Service code 28 | — | $0 |
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 | 493 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 135 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 628 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 1,156 | $121K |
| Stop-loss / reinsurancereinsurance | BERKSHIRE HATHAWAY SPECIALITY INSURANCE COMPANY | 534 | $186K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 1,156 | $121K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,156 | — |
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.