| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $988 | $387 | $1K | 13.91% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $562 | $290 | $852 | 15.16% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS | 79 W MARKET ST STE 300 BETHLEHEM, PA 18018 | HEALTHIEST YOU | $405 | $0 | $405 | 15.01% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $372 | $150 | $522 | 21.07% |
| BSI CORPORATE BENEFITS LLC3 | 28411 NORTHWESTERN HWY STE 115 SOUTHFIELD, MI 480345567 | PRINCIPAL LIFE INSURANCE COMPANY | $254 | $0 | $254 | 14.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BSI CORPORATE BENEFITS, LLC EIN 51-0467698 BROKER | Insurance agents and brokers Service code 22 | — | $16K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $7K |
| CAPITAL BLUECROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | $2K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $1K |
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 | 22 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 23 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 21 | $2K |
| Vision | CAPITAL ADVANTAGE ASSURANCE COMPANY | 40 | $2K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 34 | $6K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 34 | $10K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 22 | $83K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 34 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 40 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.