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Employer
224 Nazareth Pike, Bethlehem, PA 18020 · EIN 45-2765419 · Jul 1, 2024 to Jun 30, 2025
Plan year 2024
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Schedule A
Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.
Visible subtotal $7,582
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 45 | Comp not disclosed Premium $166,232 |
| Dental + Vision | Capital Advantage Assurance Company | Bsi Corporate Benefits, Inc. | 79 | $447 1.4% of $31,727 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 124 | $518 17.1% of $3,027 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 27 | $1,557 22.1% of $7,049 |
| Short Term Disability Voluntary | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 26 | $3,080 23.0% of $13,402 |
| Long Term Disability Voluntary | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 21 | $1,980 22.6% of $8,744 |
Schedule C
Plan-paid amounts to each named party on the filing, with the role they reported. This is not a carrier commission and is not added to Schedule A.
Visible subtotal $79,783
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits, LLC | Broker | $38,485 | $310.36 |
| The Benecon Group | Broker | $20,986 | $169.24 |
| Hy Holdings Inc | Broker | $6,642 | $53.56 |
| Capital Bluecross | Admin | $10,827 | $87.31 |
| Innovu | Other | $2,843 | $22.93 |