| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BSI CORPORATE BENEFITS LLC3 | 205 WEBSTER ST BETHLEHEM, PA 18015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $1K | $3K | 17.63% |
| BSI CORPORATE BENEFITS LLC3 | 205 WEBSTER ST BETHLEHEM, PA 18015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $786 | $2K | 22.98% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 28411 NORTHWESTERN HWY STE 1150 SOUTHFIELD, MI 48034 | THE GUARDIAN LIFE INSURANCE COMPANY | $3K | $0 | $3K | 40.88% |
| INDEPENDENCE PLANNING GROUP3 Filed as: INDEPENDENCE PLANNING GROUP, LLC | 1767 SENTRY PKWY W BLUE BELL, PA 19422 | THE GUARDIAN LIFE INSURANCE COMPANY | $15 | $0 | $15 | 0.20% |
| MAZZMAR LLC3 | 350 SENTRY PKWY #200 BLUE BELL, PA 19422 | THE GUARDIAN LIFE INSURANCE COMPANY | $15 | $0 | $15 | 0.20% |
| BSI CORPORATE BENEFITS LLC3 | 205 WEBSTER ST BETHLEHEM, PA 18015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $696 | $532 | $1K | 17.63% |
| BSI CORPORATE BENEFITS LLC3 | 205 WEBSTER ST BETHLEHEM, PA 18015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $585 | $456 | $1K | 17.78% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 29100 NORTHWESTERN HWY STE 310 SOUTHFIELD, MI 48034 | CAPITAL ADVANTAGE ASSURANCE COMPANY | $149 | $0 | $149 | 4.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE BENECON GROUP, LLC EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $45K |
| BSI CORPORATE BENEFITS, LLC EIN 51-0467698 BROKER | Insurance agents and brokers Service code 22 | — | $25K |
| INNOVU EIN 81-1938789 OTHER | Other services Service code 49 | — | $2K |
| CAPITAL BLUECROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | -$8K |
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 | 56 | 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) | 56 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY | 43 | $7K |
| Vision | CAPITAL ADVANTAGE ASSURANCE COMPANY | 94 | $4K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 56 | $6K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 56 | $7K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 56 | $15K |
| Stop-loss / reinsurancereinsurance | CRUM & FORSTER | 41 | $253K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 56 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 94 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.