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Employer
1300 Stefko Blvd, Bethlehem, PA 18017 · EIN 24-0625370 · 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 $199,450
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $1,118 |
| Stop-loss | Avalon Insurance Company | — | 490 | Comp not disclosed Premium $1,097,118 |
| Life | Prudential Insurance Company Of America | Bsi Corporate Benefits, Inc. | 573 | $199,316 18.8% of $1,058,401 |
| Life | Prudential Insurance Company Of America | Img | 573 | $134 0.0% of $1,058,401 |
| EAP | Preferred Eap | — | 619 | 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 $153,673
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $243,411 | $393.23 |
| Bsi Corporate Benefits | Broker | $234,365 | $378.62 |
| Lehigh Valley Business Conf On Heal | Broker | $316 | $0.51 |
| Prudential Insurance Company Of Ame | Admin | $34,612 | $55.92 |
| Hy Holdings Inc | Admin | $28,115 | $45.42 |
| Innovu | Other | $24,926 | $40.27 |
| United Concordia Companies, Inc. | Admin | $23,275 | $37.60 |
| Compsych | Admin | $6,129 | $9.90 |
| Capital Advantage Assurance Company | Admin | $-441,476 | $-713.21 |