| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT GROUP INSURANCE3 | 301 ALBANY TURNPIKE CANTON, CT 06019 | AMALGAMATED LIFE INSURANCE COMPANY | $8K | — | $8K | 10.00% |
| EDWARD JCHICOSKI3 | P.O. BOX 670 NEW HARTFORD, CT 06057 | THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK | $5K | — | $5K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CVS/CAREMARK EIN 75-2882129 PHARMACY BENEFIT MGMT | Claims processing Service code 12 | — | $1.9M |
| CARDAY ASSOCIATES EIN 53-0257019 NONE | Contract Administrator Service code 13 | — | $221K |
| CIGNA HEALTH & LIFE INSURANCE COMPA EIN 59-1031071 NONE | Other services; Participant communication; Direct payment from the plan; Claims processing; Non-monetary compensation; Float revenue; Named fiduciary; Contract Administrator Service code 12 | — | $213K |
| MOONEY, GREEN SAINDON, MURPHY & WEL EIN 52-1958229 NONE | Legal Service code 29 | — | $55K |
| LONGFELLOW INVESTMENT MANAGEMENT CO EIN 04-2933956 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $15K |
| PNC INSTITUTIONAL INVESTMENTS EIN 25-1211909 | Product termination fees (surrender charges, etc.); Distribution (12b-1) fees; Investment advisory (plan); Legal; Shareholder servicing fees; Custodial (securities) Service code 19 | — | $13K |
| DANIEL A. WINTERS & COMPANY, CPA EIN 23-2586736 NONE | Accounting (including auditing) Service code 10 | — | $9K |
| DAHAB ASSOCIATES EIN 11-2783874 NONE | Consulting (pension) Service code 17 | — | $6K |
| BOLTON PARTNERS, INC. EIN 52-1231144 NONE | Actuarial Service code 11 | — | $6K |
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 | 440 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 133 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 573 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK | 611 | $47K |
| Stop-loss / reinsurancereinsurance | AMALGAMATED LIFE INSURANCE COMPANY | 513 | $78K |
| Other | THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK | 611 | $47K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 611 | — |
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.