| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 79 W MARKET ST STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $4K | 15.59% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 79 W MARKET ST STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $3K | 16.25% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 79 W MARKET ST STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $825 | $2K | 16.04% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 79 W MARKET ST STE 400 BETHLEHEM, PA 18018 | DELTA DENTAL OF PENNSYLVANIA | $815 | $0 | $815 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BSI CORPORATE BENEFITS, LLC BROKER | Claims processing Service code 12 | 79 W MARKET ST STE 400 BETHLEHEM, PA 18018 | $8K |
| CAPITAL BLUE CROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | $4K |
| THE BENECON GROUP, LLC EIN 23-1315351 BROKER | Claims processing Service code 12 | — | $4K |
| HEALTHIEST YOU EIN 04-3705970 ADMIN | Claims processing Service code 12 | — | $1K |
| CONNECTCARE 3 EIN 26-1768616 OTHER | Other services Service code 49 | — | $827 |
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 | 54 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 54 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 102 | $8K |
| Vision | CAPITAL ADVANTAGE ASSURANCE COMPANY | 99 | $1K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 24 | $14K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 27 | $19K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 33 | $29K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 55 | $43K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 24 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 102 | — |
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.