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Employer
5925 Tilghman Street, Allentown, PA 18104 · EIN 45-3549892 · Dec 1, 2024 to Nov 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 $5,799
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health | — | — | Comp not disclosed Premium $16,498 |
| Stop-loss | Crum & Forster | — | 30 | Comp not disclosed Premium $161,255 |
| Dental + Vision | Capital Advantage Assurance Company | Bsi Corporate Benefits, Inc. | 70 | $2,028 9.3% of $21,896 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 39 | $563 17.9% of $3,153 |
| AD&D | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 16 | $706 22.3% of $3,170 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 12 | $1,279 23.9% of $5,351 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 38 | $1,223 18.0% of $6,807 |
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 $64,714
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $32,102 | $458.60 |
| Bsi Corporate Benefits | Broker | $18,474 | $263.91 |
| Capital Blue Cross | Admin | $10,796 | $154.23 |
| Hy Holdings Inc. DBA Healthiest You | Other | $1,769 | $25.27 |
| Innovu | Other | $1,573 | $22.47 |