| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 Filed as: LAKESHORE BENEFIT GROUP | 301 ALBANY TURNPIKE CANTON, CT 06019 | HCC LIFE INSURANCE COMPANY | $23K | — | $23K | 8.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENESYS EIN 55-0772752 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $1.8M |
| CIGNA HEALTH & LIFE INSURANCE EIN 59-1031071 NONE | Claims processing; Float revenue; Other services; Participant communication; Direct payment from the plan; Non-monetary compensation; Contract Administrator Service code 12 | — | $1.1M |
| O'DONOGHUE & O'DONOGHUE EIN 53-0120528 NONE | Legal; Direct payment from the plan Service code 29 | — | $171K |
| CALIBRE CPA GROUP, PLLC EIN 47-0900880 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $46K |
| GAMCO EIN 13-4044521 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $34K |
| NATIONAL INVESTMENT SERVICES NONE | Investment management fees paid directly by plan; Investment management Service code 28 | 777 EAST WISCONSIN AVENUE MILWAUKEE, WI 53202 | $29K |
| INVESTMENT PERFORMANCE SERVICES EIN 58-2432390 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $26K |
| PNC EIN 22-1146430 NONE | Investment management; Custodial (securities); Investment management fees paid directly by plan Service code 19 | — | $26K |
| THE SEGAL COMPANY EIN 13-1835864 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $23K |
| LINDQUIST LLP EIN 52-2385296 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $20K |
| SPENCER FANE NONE | Legal; Direct payment from the plan Service code 29 | — | $13K |
| GLENN CROUSE EIN 52-6038498 TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | — | $7K |
| WESTERN ASSET EIN 20-4712392 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $6K |
| LACY WOLF EIN 52-6038498 TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $5K |
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 | 3,467 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,651 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 5,118 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 3,561 | $1.1M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 3,561 | $1.1M |
| Other | HCC LIFE INSURANCE COMPANY | 3,561 | $293K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,561 | — |
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."
No prospect flags tripped on this filing.