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Employer
5150 Game Preserve Rd, Schnecksville, PA 18078 · EIN 05-0606070 · Dec 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 $388
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Avalon Insurance Company | — | 20 | Comp not disclosed Premium $5,238 |
| Dental | Delta Dental Of Pennsylvania | — | 31 | Schedule A not provided |
| Vision | Capital Advantage Assurance Company | Bsi Corporate Benefits, Inc. | 36 | $5 0.3% of $1,845 |
| Life | The Lincoln National Life Insurance Company | Bsi Corporate Benefits, Inc. | 38 | $39 15.0% of $260 |
| Other | The Lincoln National Life Insurance Company | Bsi Corporate Benefits, Inc. | 38 | $181 15.0% of $1,207 |
| EAP | Lehigh Valley Hospital Inc | — | — | 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 $2,311
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $1,257 | $33.08 |
| Bsi Corporate Benefits, LLC | Broker | $1,000 | $26.32 |
| Hy Holdings Inc | Admin. | $338 | $8.89 |
| Innovu | Admin. | $85 | $2.24 |
| Capital Bluecross | Admin. | $-369 | $-9.71 |