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Employer
739 North 12th Street, Allentown, PA 18102 · EIN 23-2222874 · Dec 1, 2024 to Nov 30, 2025
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 $12,546
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $14,141 |
| Stop-loss | Crum & Forster | — | 53 | Comp not disclosed Premium $128,161 |
| Dental + Vision | Highmark, Inc. | The Benecon Group, Inc. | 90 | $2,628 8.1% of $32,334 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 74 | $1,682 24.4% of $6,899 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 74 | $2,266 22.4% of $10,131 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 74 | $4,347 19.9% of $21,821 |
| Voluntary Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 30 | $1,623 25.9% of $6,258 |
| EAP | 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 $51,644
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits, LLC | Broker | $34,357 | $381.74 |
| The Benecon Group | Broker | $33,379 | $370.88 |
| Innovu | Other | $2,703 | $30.03 |
| Capital Bluecross | Admin | $-18,795 | $-208.83 |