| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BSI CORPORATE BENEFITS LLC3 | 79 W. MARKET ST, STE 400 BETHLEHEM, PA 180185749 | DELTA DENTAL OF PENNSYLVANIA | $922 | $0 | $922 | 10.00% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST, STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $575 | $595 | $1K | 20.34% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST, STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $575 | $391 | $966 | 25.19% |
| 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 | $163 | $497 | $660 | 40.44% |
| BSI CORPORATE BENEFITS LLC3 | 28411 NORTHWESTERN HWY STE 1150 SOUTHFIELD, MI 48034 | NATIONAL VISION ADMINISTRATORS NGL | $72 | $0 | $72 | 4.99% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST, STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $140 | $145 | $285 | 20.33% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BSI CORPORATE BENEFITS EIN 51-0467698 BROKER | Insurance agents and brokers Service code 22 | — | $7K |
| GEISINGER HEALTH PLAN EIN 23-2815174 ADMIN | Claims processing Service code 12 | — | $5K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $5K |
| HY HOLDINGS, INC EIN 04-3705970 ADMIN | Claims processing Service code 12 | — | $3K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $960 |
| INNOVU BROKER | Insurance agents and brokers Service code 22 | 2403 SIDNEY ST SUITE 225 PITTSBURGH, PA 15203 | $918 |
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 | 16 | 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) | 16 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 14 | $9K |
| Vision | NATIONAL VISION ADMINISTRATORS NGL | 12 | $1K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 23 | $1K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 18 | $6K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 2 | $2K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 16 | $74K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 23 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 23 | — |
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.