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Employer
500 East Centre St., Ashland, PA 17921 · EIN 81-5042835 · Jan 1, 2024 to Dec 31, 2024
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 $47,415
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $489 |
| Stop-loss | HM Life Insurance Company | — | 160 | Comp not disclosed Premium $761,852 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 207 | $6,133 17.9% of $34,296 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 44 | $6,041 23.1% of $26,123 |
| Voluntary Critical Illness | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 36 | $2,242 23.5% of $9,527 |
| Accident Only Medical | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 139 | $5,071 16.7% of $30,404 |
| Accident Only Voluntary | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 7 | $296 28.6% of $1,036 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 176 | $21,902 20.3% of $108,087 |
| Insured Hospital Indem | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 138 | $4,757 26.6% of $17,880 |
| Voluntary | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 23 | $973 9.6% of $10,185 |
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 $208,050
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits, LLC | Broker | $109,656 | $685.35 |
| The Benecon Group, LLC | Broker | $30,706 | $191.91 |
| Innovu | Broker | $7,935 | $49.59 |
| Connectcare 3 | Patient Advocate | $10,492 | $65.58 |
| Highmark Blue Shield (Central) | Admin | $-37,315 | $-233.22 |
| Lehigh Valley Business Conf | Broker | $85 | $0.41 |
| Highmark, Inc. | Admin | $81,943 | $395.86 |
| United Concordia Companies, Inc. | Admin | $4,548 | $21.97 |