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Employer
4085 Independence Dr., Schnecksville, PA 18078 · EIN 23-1353394 · 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 $97,496
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $2,705 |
| Stop-loss | Avalon Insurance Company | — | 956 | Comp not disclosed Premium $737,774 |
| Vision | Eyemed Vision Care | — | 1182 | Comp not disclosed Premium $78,787 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 1397 | $11,761 8.2% of $142,909 |
| AD&D | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 213 | $29,750 25.8% of $115,162 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 1112 | $27,926 10.2% of $274,705 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 1112 | $28,059 10.1% of $277,249 |
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 $-518,173
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $234,519 | $167.87 |
| Bsi Corporate Benefits, LLC | Broker | $53,492 | $38.29 |
| Innovu | Other | $51,544 | $36.90 |
| United Concordia Companies, Inc. | Admin | $47,715 | $34.16 |
| Capital Advantage Insurance Company | Admin | $-905,443 | $-648.13 |