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Employer
205 Webster Street, Bethlehem, PA 18015 · EIN 51-0467698 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
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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 $3,320
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Crum & Forster | — | 47 | Comp not disclosed Premium $213,878 |
| Vision | Capital Advantage Assurance Company | — | — | Schedule A not provided |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 54 | $688 7.6% of $9,034 |
| AD&D | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 36 | $792 6.2% of $12,698 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 55 | $805 7.4% of $10,839 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 55 | $1,035 7.5% of $13,727 |
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 $36,635
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $44,787 | $814.31 |
| Innovu | Broker | $2,261 | $41.11 |
| Bsi Corporate Benefits, LLC | Broker | $-443 | $-8.05 |
| Capital Bluecross | Admin | $-9,970 | $-181.27 |