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Employer
1990 Highland Avenue, Bethlehem, PA 18020 · EIN 11-1992329 · 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 $30,609
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 94 | Comp not disclosed Premium $366,395 |
| Dental + Vision | The Guardian Life Insurance Company Of America | Bsi Corporate Benefits, Inc. | 97 | $7,786 29.8% of $26,158 |
| Dental + Vision | The Guardian Life Insurance Company Of America | Independence Planning Group, LLP | 97 | $39 0.1% of $26,158 |
| Dental + Vision | The Guardian Life Insurance Company Of America | Mazzmar LLC | 97 | $39 0.1% of $26,158 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 124 | $2,178 17.5% of $12,479 |
| AD&D | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 60 | $6,023 22.5% of $26,738 |
| Vol. Ltd | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 47 | $6,934 24.2% of $28,632 |
| Vol. Std | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 67 | $7,610 24.1% of $31,583 |
| Telemedicine | Healthiest You | — | — | 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 $68,742
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefit LLC | Broker | $64,753 | $688.86 |
| The Benecon Group, LLC | Broker | $28,105 | $298.99 |
| Innovu | Broker | $4,934 | $52.49 |
| Capital Bluecross | Admin. | $-29,050 | $-309.04 |