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Employer
252 Brodhead Road, Bethlehem, PA 18017 · EIN 23-1724466 · 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 $10,350
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Crum & Forster | — | 41 | Comp not disclosed Premium $253,329 |
| Dental | The Guardian Life Insurance Company | Bsi Corporate Benefits, Inc. | 43 | $3,020 40.9% of $7,387 |
| Dental | The Guardian Life Insurance Company | Independence Planning Group, LLC | 43 | $15 0.2% of $7,387 |
| Dental | The Guardian Life Insurance Company | Mazzmar LLC | 43 | $15 0.2% of $7,387 |
| Vision | Capital Advantage Assurance Company | Bsi Corporate Benefits, Inc. | 94 | $149 4.0% of $3,726 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 56 | $1,041 17.8% of $5,854 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 56 | $2,618 17.6% of $14,850 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 56 | $1,228 17.6% of $6,964 |
| Vol. Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 17 | $2,264 23.0% of $9,854 |
| Telemedicine | Teladoc Health, Inc. | — | — | 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 $63,984
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $45,299 | $481.90 |
| Bsi Corporate Benefits, LLC | Broker | $25,126 | $267.30 |
| Innovu | Other | $2,053 | $21.84 |
| Capital Bluecross | Admin | $-8,494 | $-90.36 |