| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET STREET SUITE 400 BETHLEHEM, PA 180185749 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $616 | $366 | $982 | 15.95% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET STREET SUITE 400 BETHLEHEM, PA 180185749 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $862 | $346 | $1K | 21.03% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET STREET SUITE 400 BETHLEHEM, PA 180185749 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $675 | $266 | $941 | 20.91% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET STREET SUITE 400 BETHLEHEM, PA 180185749 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $301 | $179 | $480 | 15.95% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 29100 NORTHWESTERN HWY. SUITE 310 SOUTHFIELD, MI 48034 | CAPITAL ADVANTAGE ASSURANCE COMPANY | $1K | $0 | $1K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITAL BLUE CROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | $17K |
| BSI CORPORATE BENEFITS BROKER | Insurance agents and brokers Service code 22 | 79 WEST MARKET STREET SUITE 400 BETHLEHEM, PA 18018 | $16K |
| THE BENECON GROUP, LLC EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $8K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $2K |
| HY HOLDINGS INC. DBA HEALTHIEST YOU EIN 26-1306606 ADMIN | Claims processing Service code 12 | — | $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 | 33 | 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) | 33 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CAPITAL ADVANTAGE ASSURANCE COMPANY | 55 | $0 |
| Vision | CAPITAL ADVANTAGE ASSURANCE COMPANY | 55 | $0 |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 33 | $3K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 32 | $6K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 12 | $6K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 38 | $124K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 33 | $8K |
| 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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.