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Employer
1670 E Race St, Allentown, PA 18109 · EIN 23-2819753 · 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 $6,605
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $773 |
| Stop-loss | Crum & Forster | — | 32 | Comp not disclosed Premium $209,600 |
| Dental | United Concordia Insurance Company | — | 62 | Schedule A not provided |
| Vision | Capital Advantage Assurance Company | — | 68 | Schedule A not provided |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 42 | $610 18.9% of $3,231 |
| AD&D | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 16 | $1,628 25.4% of $6,415 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 42 | $1,556 18.7% of $8,299 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 42 | $1,040 18.6% of $5,585 |
| 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 $59,047
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $38,971 | $573.10 |
| Bsi Corporate Benefits, LLC | Broker | $23,311 | $342.81 |
| Hy Holdings Inc | Admin | $3,629 | $53.37 |
| Innovu | Other | $1,602 | $23.56 |
| Capital Bluecross | Admin | $-8,466 | $-124.50 |