| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 28411 NORTHWESTERN HWY SUITE 1150 SOUTHFIELD, MI 48034 | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | $2K | $0 | $2K | 9.99% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST, STE 400 BETHLEHEM, PA 18018 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $0 | $2K | 12.14% |
| SHAWN HUGHES3 | 79 W MARKET ST, STE 400 BETHLEHEM, PA 18018 | AMFIRST | $2K | $0 | $2K | 15.00% |
| MWL3 | PO BOX 14067 JACKSON, MS 392364067 | AMFIRST | $697 | $0 | $697 | 5.00% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST, STE 400 BETHLEHEM, PA 18018 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $0 | $2K | 16.27% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST, STE 400 BETHLEHEM, PA 18018 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $0 | $2K | 16.27% |
| BSI CORPORATE BENEFITS LLC3 | 28411 NORTHWESTERN HWY STE 1150 SOUTHFIELD, MI 48034 | CAPITAL BLUE CROSS | $155 | $0 | $155 | 4.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BSI CORPORATE BENEFITS, LLC BROKER | Insurance agents and brokers Service code 22 | 79 W MARKET ST, SUITE 400 BETHLEHEM, PA 18018 | $23K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $11K |
| CAPITAL BLUE CROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | $8K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $2K |
| HY HOLDINGS INC. ADMIN | Claims processing Service code 12 | 9160 E BAHIA DR STE 201 SCOTTSDALE, AZ 85260 | $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 | 35 | 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) | 37 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | 55 | $21K |
| Vision | CAPITAL BLUE CROSS | 41 | $4K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $14K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $10K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 37 | $99K |
| Other(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 6 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 55 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.