| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BSI CORPORATE BENEFITS LLC3 | 205 WEBSTER ST BETHLEHEM, PA 18015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $381 | $0 | $381 | 1.50% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 28411 NORTHWESTERN HWY, STE 150 SOUTHFIELD, MI 48034 | THE GUARDIAN LIFE INSURANCE COMPANY | $704 | $0 | $704 | 7.32% |
| INDEPENDENCE PLANNING GROUP3 | — | THE GUARDIAN LIFE INSURANCE COMPANY | $4 | $0 | $4 | 0.04% |
| MAZZMAR LLC3 | — | THE GUARDIAN LIFE INSURANCE COMPANY | $4 | $0 | $4 | 0.04% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS | 205 WEBSTER ST BETHLEHEM, PA 10815 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $586 | $0 | $586 | 15.01% |
| BSI CORPORATE BENEFITS LLC3 | 205 WEBSTER ST BETHLEHEM, PA 18015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $253 | $0 | $253 | 14.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BSI CORPORATE BENEFITS, LLC EIN 51-0467698 BROKER | Insurance agents and brokers Service code 22 | — | $6K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $3K |
| HY HOLDINGS EIN 04-3705970 ADMIN | Claims processing Service code 12 | — | $1K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $617 |
| INNOVU OTHER | Other services Service code 49 | 2403 SIDNEY ST SUITE 225 PITTSBURGH, PA 15203 | $480 |
| HIGHMARK BCBS NEPA EIN 23-2413324 ADMIN | Claims processing Service code 12 | — | -$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 | 70 | 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) | 70 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY | 59 | $10K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY | 59 | $10K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 70 | $2K |
| Short-term disability(2 contracts, 2 carriers) | OPTUM HEALTH (UNIMERICA INSURANCE COMPANY) | 70 | $66K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 70 | $25K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 70 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 70 | — |
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.