| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 29100 NORTHWESTERN HIGHWAY SUITE 300 SOUTHFIELD, MI 48034 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $0 | $2K | 6.22% |
| MMA SERVICE CORP3 | 620 S CAPITOL AVE LANSING, MI 48933 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $1K | $1K | 5.00% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $438 | $438 | 4.80% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $345 | $345 | 4.82% |
| 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 | $0 | $304 | $304 | 4.88% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $250 | $250 | 4.16% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 29100 NORTHWESTERN HIGHWAY SUITE 10 SOUTHFIELD, MI 48034 | CAPITAL ADVANTAGE ASSURANCE COMPANY | $104 | $0 | $104 | 4.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE BENECON GROUP, LLC EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $8K |
| CAPITAL BLUE CROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | $5K |
| CONNECTCARE3 LLC EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $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 | 37 | 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) | 37 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 62 | $27K |
| Vision | CAPITAL ADVANTAGE ASSURANCE COMPANY | 31 | $3K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 37 | $6K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 37 | $9K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 37 | $7K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 31 | $107K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 37 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 62 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.