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Employer
2210 City Line Road, Bethlehem, PA 18017 · EIN 23-1729679 · Jan 1, 2024 to Dec 31, 2024
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 $12,213
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 154 | Comp not disclosed Premium $623,549 |
| Vision | Highmark Inc. | Kachelries, Robert G | 274 | $554 4.4% of $12,619 |
| Vision | Highmark Inc. | The Benecon Group, Inc. | 274 | $277 2.2% of $12,619 |
| Life | United Of Omaha Life Insurance Company | Usi Insurance Srvcs LLC New England | 216 | $1,809 3.6% of $50,386 |
| AD&D | United Of Omaha Life Insurance Company | Usi Insurance Srvcs LLC New England | 57 | $5,886 18.8% of $31,297 |
| Other | United Of Omaha Life Insurance Company | Usi Insurance Srvcs LLC New England | 215 | $2,061 3.7% of $55,895 |
| Other | United Of Omaha Life Insurance Company | Usi Insurance Srvcs LLC New England | 216 | $1,626 3.6% of $45,519 |
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 $187,485
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Usi Insurance Services (Ri) | Broker | $46,552 | $169.90 |
| The Benecon Group | Broker | $29,931 | $109.24 |
| Innovu | Broker | $8,041 | $29.35 |
| Bsi Corporate Benefits | Broker | $2,712 | $9.90 |
| Capital Advantage Assurance Company | Admin | $65,756 | $239.99 |
| Healthiest You | Admin | $18,082 | $65.99 |
| ConnectCare3 | Patient Advocate | $10,236 | $37.36 |
| United Concordia Companies, Inc. | Admin | $6,175 | $22.54 |