Employer

Christmas City Hotel, L.L.C.

437 Main Street, Bethlehem, PA 18018 · EIN 25-1825336 · Jan 1, 2025 to Dec 31, 2025

Plan year 2025

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Schedule A

Direct compensation

Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.

Visible subtotal $15,399

Coverage	Carrier	Broker	Lives	Direct comp
Stop-loss	HM Life Insurance Company	—	54	Comp not disclosed Premium $207,825
Dental	The Lincoln National Life Insurance Company	Keystone Ins & Bnfts Grp LLC	50	$2,797 15.6% of $17,959
Dental	The Lincoln National Life Insurance Company	Keystone Insurers Group LLC	50	$539 3.0% of $17,959
Life	The Lincoln National Life Insurance Company	Keystone Ins & Bnfts Grp LLC	66	$1,665 25.4% of $6,563
Life	The Lincoln National Life Insurance Company	Keystone Insurers Group LLC	66	$328 5.0% of $6,563
AD&D	The Lincoln National Life Insurance Company	Keystone Ins & Bnfts Grp LLC	13	$903 28.2% of $3,206
AD&D	The Lincoln National Life Insurance Company	Keystone Insurers Group LLC	13	$160 5.0% of $3,206
Vol Vision	The Lincoln National Life Insurance Company	Keystone Ins & Bnfts Grp LLC	54	$606 12.6% of $4,808
Other	The Lincoln National Life Insurance Company	Keystone Ins & Bnfts Grp LLC	66	$3,545 25.5% of $13,884
Other	The Lincoln National Life Insurance Company	Keystone Insurers Group LLC	66	$694 5.0% of $13,884
Other	The Lincoln National Life Insurance Company	Keystone Ins & Bnfts Grp LLC	66	$3,480 25.5% of $13,637
Other	The Lincoln National Life Insurance Company	Keystone Insurers Group LLC	66	$682 5.0% of $13,637

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 $52,066

Party	Type	Amount	$ / Enrolled / Year
The Benecon Group	Broker	$52,184	$790.67
Seltzer Group (Stuart Benefits Cons	Broker	$15,932	$241.39
Capital Bluecross	Admin	$-16,050	$-243.18

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