| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BSI CORPORATE BENEFITS LLC3 | — | DELTA DENTAL OF PENNSYLVANIA | $3K | $0 | $3K | 10.00% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS | 205 WEBSTER ST BETHLEHEM, PA 18015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $148 | $3K | 10.58% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS | 205 WEBSTER ST BETHLEHEM, PA 18015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $87 | $1K | 15.94% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS | 205 WEBSTER ST BETHLEHEM, PA 18015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $634 | $209 | $843 | 13.29% |
| BSI CORPORATE BENEFITS LLC3 | 205 WEBSTER ST BETHLEHEM, PA 18015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $593 | $37 | $630 | 10.62% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 205 WEBSTER ST BETHLEHEM, PA 18015 | NATIONAL VISION ADMINISTRATORS, LLC | $266 | $0 | $266 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BSI CORPORATE BENEFITS, LLC EIN 51-0467698 BROKER | Insurance agents and brokers Service code 22 | — | $40K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $15K |
| INDEPENDENCE ADMINISTRATORS (IA) EIN 23-2184623 ADMIN | Claims processing Service code 12 | — | $8K |
| HY HOLDINGS INC EIN 04-3705970 ADMIN | Claims processing Service code 12 | — | $7K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $4K |
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 | 74 | 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) | 74 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 51 | $32K |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 91 | $5K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 74 | $6K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 74 | $25K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 60 | $293K |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 74 | $22K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 91 | — |
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.