| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST STE 300 BETHLEHEM, PA 18018 | DELTA DENTAL OF PENNSYLVANIA | $226 | $0 | $226 | 10.00% |
| BSI CORPORATE BENEFITS LLC3 | 205 WEBSTER ST BETHLEHEM, PA 18015 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $105 | $0 | $105 | 14.02% |
| BSI CORPORATE BENEFITS LLC3 | 205 WEBSTER ST BETHLEHEM, PA 18015 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $110 | $0 | $110 | 15.03% |
| BSI CORPORATE BENEFITS LLC3 | 205 WEBSTER ST BETHLEHEM, PA 18015 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $95 | $0 | $95 | 14.98% |
| KOLE, ROBERT3 | 13 HERITAGE CT CARLISLE, PA 17015 | HIGHMARK, INC. | $18 | $0 | $18 | 3.50% |
| THE BENECON GROUP3 Filed as: THE BENECON GROUP, LLC | PO BOX 5406 LANCASTER, PA 17606 | HIGHMARK, INC. | $9 | $0 | $9 | 1.75% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BSI CORPORATE BENEFITS, LLC EIN 51-0467698 BROKER | Insurance agents and brokers Service code 22 | — | $2K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $1K |
| HY HOLDINGS INC EIN 04-3705970 ADMIN | Claims processing Service code 12 | — | $371 |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $218 |
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 | 40 | 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) | 40 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 52 | $2K |
| Vision | HIGHMARK, INC. | 46 | $514 |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 61 | $634 |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 60 | $749 |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 61 | $732 |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 40 | $10K |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 61 | $634 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 61 | — |
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.