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Employer
516 Iron Street, Lehighton, PA 18235 · EIN 23-2708301 · 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 $10,272
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Crum & Forster | — | 70 | Comp not disclosed Premium $397,715 |
| Dental + Vision | The Guardian Life Insurance Company | — | 75 | Schedule A not provided |
| Dental + Vision | The Guardian Life Insurance Company | — | 75 | Schedule A not provided |
| Dental + Vision | The Guardian Life Insurance Company | — | 75 | Schedule A not provided |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 69 | $1,423 15.5% of $9,166 |
| Other | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $412 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 69 | $2,138 15.5% of $13,771 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 69 | $3,289 15.5% of $21,186 |
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 $106,906
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $75,594 | $1,007.92 |
| Bsi Corporate Benefits, LLC | Broker | $40,203 | $536.04 |
| Hy Holdings | Admin | $7,216 | $96.21 |
| Innovu | Other | $3,298 | $43.97 |
| Highmark Bcbs Nepa | Admin | $-19,405 | $-258.73 |