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Employer
2171 28th Street, S.W., Allentown, PA 18103 · EIN 23-1731034 · 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 $12,023
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Vision | Vision Benefits Of America | — | — | Schedule A not provided |
| Life | Hartford Life And Accident | Bsi Corporate Benefits, Inc. | 776 | $12,023 4.1% of $296,656 |
| Supplemental | Aflac | — | — | Schedule A not provided |
| Supplemental | Aflac | — | — | Schedule A not provided |
| Supplemental | Aflac | — | — | Schedule A not provided |
| Supplemental | Aflac | — | — | Schedule A not provided |
| Supplemental | Aflac | — | — | Schedule A not provided |
| Supplemental | Aflac | — | — | Schedule A not provided |
| Supplemental | Aflac | — | — | 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 $279,185
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Highmark | Admin | $279,185 | $359.77 |
| Geisinger Health Plan | Admin | Comp not disclosed | — |
| United Concordia Companies, Inc. | Admin | Comp not disclosed | — |