| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP | 529 MAIN STREET SUITE 2B NEW HARTFORD, CT 06057 | HCC LIFE INSURANCE COMPANY - TOKIO MARINE HCC | $47K | — | $47K | 8.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CARDAY ASSOCIATES, INC EIN 53-0257019 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $1.7M |
| CAREFIRST BLUE CROSS EIN 53-0078070 NONE | Direct payment from the plan; Other fees Service code 50 | — | $1.1M |
| O'DONOGHUE & O'DONOGHUE EIN 53-0120528 NONE | Legal; Direct payment from the plan Service code 29 | — | $104K |
| OONSP NONE | Other fees; Direct payment from the plan Service code 50 | — | $65K |
| CIGNA HEALTHCARE EIN 06-0303370 NONE | Other fees; Direct payment from the plan Service code 50 | — | $61K |
| GALLAGHER FIDUCIARY ADVISORS EIN 36-4291971 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $47K |
| SALTER & CO, CPA'S EIN 20-8078757 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $46K |
| GAMCO EIN 13-4044521 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $35K |
| LINDQUIST LLP EIN 52-2385296 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $25K |
| THE SEGAL COMPANY EIN 13-1835864 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $24K |
| NOVAK BIRKS PC NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | 4600 MADISON AVENUE KANSAS CITY, MO 64112 | $8K |
| JIMMY FISH EIN 52-6038498 TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | — | $8K |
| PNC EIN 22-1146430 NONE | Investment management; Investment management fees paid directly by plan; Custodial (securities); Soft dollars commissions Service code 19 | — | $8K |
| ANTHONY PERRONE EIN 52-6038498 TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $7K |
| GLENN CROUSE EIN 52-6038498 TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | — | $7K |
| KEVIN WHITESEL EIN 52-6038498 NONE | Trustee (individual); Direct payment from the plan Service code 20 | — | $7K |
| JAMES STEPHENS EIN 52-6038498 NONE | Trustee (individual); Direct payment from the plan Service code 20 | — | $5K |
| AGH BUSINESS ADVISORS, CPA'S EIN 58-2588678 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $5K |
| WELLINGTON MANAGEMENT COMPANY EIN 04-2755549 NONE | Soft dollars commissions; Investment management fees paid directly by plan; Investment management Service code 28 | — | $3K |
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 | 2,773 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,503 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 4,276 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Other(2 contracts, 2 carriers) | HCC LIFE INSURANCE COMPANY - TOKIO MARINE HCC | 4,199 | $658K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,199 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.