| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BSI CORPORATE BENEFITS LLC3 | 79 W. MARKET ST SUITE 400 BETHLEHEM, PA 180185749 | AMERITAS | $2K | $0 | $2K | 10.00% |
| 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 | $890 | $520 | $1K | 15.84% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST, STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $529 | $296 | $825 | 15.61% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST, STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $789 | $293 | $1K | 20.57% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST, STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $315 | $189 | $504 | 16.02% |
| BSI CORPORATE BENEFITS LLC3 | 28411 NORTHWESTERN HWY SUITE 1150 SOUTHFIELD, MI 48034 | NATIONAL VISION ADMINISTRATORS NGL | $127 | $0 | $127 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GEISINGER HEALTH PLAN EIN 23-2815174 ADMIN | Claims processing Service code 12 | — | $19K |
| BSI CORPORATE BENEFITS BROKER | Insurance agents and brokers Service code 22 | 79 WEST MARKET ST, SUITE 400 BETHLEHEM, PA 18018 | $16K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $11K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $2K |
| HY HOLDINGS, INC ADMIN | Claims processing Service code 12 | 5350 E HIGH ST STE 350 PHOENIX, AZ 85054 | $2K |
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 | 93 | 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) | 94 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS | 81 | $18K |
| Vision | NATIONAL VISION ADMINISTRATORS NGL | 51 | $3K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 93 | $3K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 22 | $5K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 30 | $9K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 40 | $143K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 93 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 93 | — |
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."
No prospect flags tripped on this filing.