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Employer
561 East Market Street, Bethlehem, PA 18018 · EIN 24-0795968 · 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 $5,967
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $685 |
| Stop-loss | HM Life Insurance Company | — | 89 | Comp not disclosed Premium $317,469 |
| Dental + Vision | Highmark Inc. | Dare, Anthony J | 98 | $2,179 6.5% of $33,440 |
| Dental + Vision | Highmark Inc. | The Benecon Group, Inc. | 98 | $622 1.9% of $33,440 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 125 | $1,104 16.2% of $6,820 |
| AD&D | Untied Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 17 | $394 11.1% of $3,554 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 25 | $1,098 5.3% of $20,648 |
| Vol Ltd | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 18 | $570 7.1% of $8,044 |
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 $88,738
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits, LLC | Broker | $58,032 | $652.04 |
| Hy Holdings, Inc | Broker | $21,043 | $236.44 |
| The Benecon Group, LLC | Broker | $19,975 | $224.44 |
| Innovu | Broker | $4,314 | $48.47 |
| Connectcare 3 | Patient Advocate | $5,602 | $62.94 |
| Highmark Blue Shield (Central) | Admin | $-20,228 | $-227.28 |