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Employer
925 Harvard Ave., Bethlehem, PA 18015 · EIN 90-0180806 · 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 $6,825
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $888 |
| Stop-loss | Crum & Forster | — | 64 | Comp not disclosed Premium $328,233 |
| Dental | United Concordia Insurance Company | — | 97 | Schedule A not provided |
| Vision | Capital Advantage Assurance Company | Bsi Corporate Benefits, Inc. | 95 | $252 4.0% of $6,311 |
| Life | Companion Life Insurance Company | Bsi Corporate Benefits, Inc. | 61 | $2,192 13.4% of $16,320 |
| Life | Companion Life Insurance Company | Consolidated Benefits, Inc. | 61 | $1 0.0% of $16,320 |
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 $107,840
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $67,945 | $700.46 |
| Bsi Corporate Benefits, LLC | Broker | $50,464 | $520.25 |
| Hy Holdings Inc | Admin | $3,885 | $40.05 |
| Innovu | Other | $3,430 | $35.36 |
| Capital Bluecross | Admin | $-17,884 | $-184.37 |