| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 79 W MARKET STREET #400 BETHLEHEM, PA 18010 | DELTA DENTAL - SBA PA | $157 | $0 | $157 | 9.34% |
| ENROLLEASE3 Filed as: STRATEGIC BENEFIT DESIGNS INC | 142 STOKESAY CASTLE LANE READING, PA 19606 | DEARBORN LIFE INSURANCE COMPANY | $158 | $0 | $158 | 15.74% |
| CONSOLIDATED BENEFITS INC3 Filed as: CONSOLIDATED BENEFITS INC. | 2500 ELMERTON AVENUE HARRISBURG, PA 17177 | DEARBORN LIFE INSURANCE COMPANY | $0 | $53 | $53 | 5.28% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 29100 NORTHWESTERN HWY. SUITE 310 SOUTHFIELD, MI 48034 | CAPITAL ADVANTAGE ASSURANCE COMPANY | $10 | $0 | $10 | 3.92% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITAL BLUE CROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | $4K |
| BSI CORPORATE BENEFITS BROKER | Insurance agents and brokers Service code 22 | 79 WEST MARKET STREET SUITE 400 BETHLEHEM, PA 18018 | $1K |
| THE BENECON GROUP, LLC EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $757 |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $151 |
| HEALTHIEST YOU EIN 30-0947669 ADMIN | Claims processing Service code 12 | — | $145 |
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 | 31 | 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) | 32 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL - SBA PA | 30 | $2K |
| Vision | CAPITAL ADVANTAGE ASSURANCE COMPANY | 69 | $255 |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 31 | $1K |
| Short-term disability | DEARBORN LIFE INSURANCE COMPANY | 31 | $1K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 29 | $9K |
| Other | DEARBORN LIFE INSURANCE COMPANY | 31 | $1K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 69 | — |
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.