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Employer
383 Minor Street, Emmaus, PA 18049 · EIN 23-1676347 · 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 $9,688
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $430 |
| Stop-loss | Crum & Forster | — | 47 | Comp not disclosed Premium $191,010 |
| Dental + Vision | The Guardian Life Insurance Company Of America | Bsi Corporate Benefits, Inc. | 53 | $3,058 8.2% of $37,449 |
| Dental + Vision | The Guardian Life Insurance Company Of America | Mazzmar, LLC | 53 | $36 0.1% of $37,449 |
| Vision | National Vision Administrators, LLC | Bsi Corporate Benefits, Inc. | 93 | $225 5.0% of $4,508 |
| Life | Metropolitan Life Insurance Company | — | — | Schedule A not provided |
| Telemedicine | Healthiest You | — | — | Schedule A not provided |
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 $73,008
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $40,787 | $438.57 |
| Bsi Corporate Benefits, LLC | Broker | $33,167 | $356.63 |
| Hy Holdings Inc | Admin | $5,771 | $62.05 |
| Innovu | Other | $2,623 | $28.20 |
| Highmark Blue Shield (Central) | Admin | $-9,340 | $-100.43 |