| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 | INSURANCE BROKERAGE, LLC PO BOX 670 NEW HARTFORD, CT 06057 | THE UNION LABOR LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CARDAY ASSOCIATES, INC. EIN 53-0257019 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $331K |
| CONIFER HEALTH SOLUTIONS EIN 52-1964905 NONE | Direct payment from the plan; Other services; Other fees Service code 49 | — | $106K |
| SEGALL BRYANT & HAMILL EIN 41-1788385 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $39K |
| SLEVIN & HART, P.C. EIN 52-1708613 NONE | Legal; Direct payment from the plan Service code 29 | — | $34K |
| AMERICAN REALTY EIN 33-0123114 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $30K |
| WITHUMSMITH & BROWN, P.C. EIN 22-2027092 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $28K |
| PNC EIN 22-1146430 NONE | Direct payment from the plan; Custodial (securities) Service code 19 | — | $25K |
| CHEIRON, INC. EIN 13-4215617 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $12K |
| PENN CAPITAL MANAGEMENT EIN 22-2796848 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $12K |
| OPTUM RX EIN 62-1451147 NONE | Direct payment from the plan; Other services Service code 49 | — | $10K |
| INVESTMENT PERFORMANCE SERVICE EIN 58-2432390 NONE | Direct payment from the plan; Investment advisory (plan); Consulting (general) Service code 16 | — | $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 | 968 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 82 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 1,050 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GROUP DENTAL SERVICE OF MARYLAND, INC. | 1,349 | $272K |
| Vision | FIDELITY SECURITY LIFE INSURANCE | 1,424 | $38K |
| Life insurance | THE UNION LABOR LIFE INSURANCE COMPANY | 980 | $20K |
| Other | THE UNION LABOR LIFE INSURANCE COMPANY | 980 | $20K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,424 | — |
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.