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Employer
4243 Lonat Drive, Nazareth, PA 18064 · EIN 23-2158273 · Jul 1, 2024 to Jun 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 $8,451
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 55 | Comp not disclosed Premium $285,819 |
| Dental | Capital Advantage Assurance Company | — | 110 | Comp not disclosed Premium $39,435 |
| Vision | Vision Service Plan | Bsi Corporate Benefits, Inc. | 85 | $488 9.9% of $4,912 |
| Short Term Disability Voluntary | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 19 | $2,479 21.8% of $11,374 |
| Long Term Disability Voluntary | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 21 | $3,153 22.8% of $13,809 |
| Term Life - Voluntary | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 27 | $2,331 22.1% of $10,568 |
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 $85,902
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits | Broker | $34,503 | $313.66 |
| The Benecon Group | Broker | $15,850 | $144.09 |
| Capital Bluecross | Admin | $23,485 | $213.50 |
| Healthiest You | Admin | $9,357 | $85.06 |
| Innovu | Other | $2,707 | $24.61 |