| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 5.60% |
| BSI CORPORATE BENEFITS LLC3 | 28411 NORTHWESTERN HWY STE 1150 SOUTHFIELD, MI 48034 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $279 | $0 | $279 | 0.84% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS | 79 W MARKET ST STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $2K | $9K | 30.85% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS | 79 W MARKET ST STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 16.28% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS | 79 W MARKET ST STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $754 | $2K | 16.68% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITAL BLUE CROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | $249K |
| BSI CORPORATE BENEFITS BROKER | Claims processing Service code 12 | 79 W MARKET ST STE 400 BETHLEHEM, PA 18018 | $75K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Claims processing Service code 12 | — | $25K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $9K |
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 | 167 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 169 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 127 | $33K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 127 | $33K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 167 | $11K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 146 | $51K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 167 | $30K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 138 | $682K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 167 | $42K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 167 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.