| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BSI CORPORATE BENEFITS LLC3 | 29100 NORTHWESTERN HWY. SUITE 310 SOUTHFIELD, MI 48034 | AVALON INSURANCE COMPANY | $24K | $0 | $24K | 7.80% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST SUITE 400 BETHLEHEM, PA 180185749 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $6K | $11K | 7.70% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST SUITE 400 BETHLEHEM, PA 180185749 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $20K | $7K | $26K | 22.82% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST SUITE 400 BETHLEHEM, PA 180185749 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $5K | $11K | 10.10% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST SUITE 400 BETHLEHEM, PA 180185749 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 3.64% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITAL ADVANTAGE ASSURANCE COMPANY EIN 45-5492167 ADMIN FEES | Claims processing Service code 12 | — | $500K |
| UNITED CONCORDIA EIN 25-1687586 ADMIN FEES | Claims processing Service code 12 | — | $38K |
| BASIC ADMIN FEES | Claims processing Service code 12 | 9246 PORTAGE INDUSTRIAL DR. PORTAGE, MI 49024 | $34K |
| HUMAN RESOURCE ADMINISTRATORS ADMIN FEES | Claims processing Service code 12 | 1541 ALTA DRIVE SUITE 306 WHITEHALL, PA 18052 | $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 | 1,547 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,560 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,547 | $186K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,267 | $148K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,267 | $105K |
| Stop-loss / reinsurancereinsurance | AVALON INSURANCE COMPANY | 1,086 | $308K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,547 | $186K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,547 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.