| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI COOPERATE BENEFITS LLC | 79 W MARKET ST STE 400 BETHLEHEM, PA 18018 | HARTFORD LIFE & ACCIDENT INSURANCE | $4K | $0 | $4K | 13.11% |
| ASHNER AGENCY LLC3 | PO BOX 66 BATH, PA 18014 | HARTFORD LIFE & ACCIDENT INSURANCE | $275 | $0 | $275 | 0.94% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BSI CORPORATE BENEFITS EIN 51-0467698 BROKER | Insurance agents and brokers Service code 22 | — | $29K |
| BENECON GROUP, LLC EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $10K |
| HY HOLDINGS INC EIN 04-3705970 ADMIN | Claims processing Service code 12 | — | $4K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $3K |
| INNOVU EIN 81-1938789 OTHER | Other services Service code 49 | — | $2K |
| CAPITAL BLUECROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | -$14K |
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 | 41 | 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) | 41 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 0 | $0 |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 0 | $0 |
| Life insurance | HARTFORD LIFE & ACCIDENT INSURANCE | 63 | $29K |
| Short-term disability | HARTFORD LIFE & ACCIDENT INSURANCE | 63 | $29K |
| Stop-loss / reinsurancereinsurance | OPTUM HEALTH | 41 | $215K |
| Other | HARTFORD LIFE & ACCIDENT INSURANCE | 63 | $29K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 63 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.