| 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 | THE GUARDIAN LIFE INSURANCE COMPANY | $3K | $0 | $3K | 39.76% |
| INDEPENDENCE PLANNING GROUP3 | 1767 SENTRY PKWY W BLUE BELL, PA 19422 | THE GUARDIAN LIFE INSURANCE COMPANY | $20 | $0 | $20 | 0.30% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 79 W. MARKET ST SUITE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $378 | $166 | $544 | 14.38% |
| 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 | $262 | $116 | $378 | 14.44% |
| 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 | $304 | $148 | $452 | 22.27% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 29100 NORTHWESTERN HWY SUITE 310 SOUTHFIELD, MI 48034 | CAPITAL ADVANTAGE ASSURANCE COMPANY | $72 | — | $72 | 5.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BSI CORPORATE BENEFITS BROKER | Insurance agents and brokers Service code 22 | 79 WEST MARKET ST SUITE 400 BETHLEHEM, PA 18018 | $20K |
| THE BENECON GROUP, LLC EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $9K |
| CAPITAL BLUE CROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | $4K |
| TELEDOC/HEALTHIEST YOU EIN 04-3705970 ADMIN | Claims processing Service code 12 | — | $3K |
| CONNECTCARE 3 EIN 26-1768661 PATIENT ADVOCATE | Other services Service code 49 | — | $1K |
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 | 39 | 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) | 39 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY | 33 | $7K |
| Vision | CAPITAL ADVANTAGE ASSURANCE COMPANY | 41 | $1K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 39 | $3K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 39 | $4K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 27 | $107K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 39 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 41 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.