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Employer
14 Brick Kiln Ct., Northampton, PA 18067 · EIN 23-2827092 · 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 $23,439
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | Delta Dental Of Pennsylvania | Bsi Corporate Benefits, Inc. | 202 | $5,480 10.0% of $54,802 |
| Vision | Capital Advantage Assurance Company | Bsi Corporate Benefits, Inc. | 189 | $680 5.8% of $11,759 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 135 | $2,450 18.4% of $13,293 |
| AD&D | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 64 | $5,529 25.5% of $21,707 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 129 | $4,578 18.4% of $24,864 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 129 | $4,722 18.6% of $25,436 |
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $1,323 |
| Stop-loss | Crum & Forster | — | 109 | Comp not disclosed Premium $588,939 |
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 $112,776
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $108,772 | $937.69 |
| Bsi Corporate Benefits, LLC | Broker | $71,107 | $612.99 |
| Hy Holdings Inc | Admin | $6,090 | $52.50 |
| Innovu | Other | $5,483 | $47.27 |
| Capital Bluecross | Admin | $-78,676 | $-678.24 |